STD Prevention: Genital Herpes
What is genital herpes?
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreaks. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
How common is genital herpes?
Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. Between the late 1970s and the early 1990s, the number of Americans with genital herpes infection increased 30 percent.
HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be due to male-to-female transmissions being more efficient than female-to-male transmission.
How do people get genital herpes?
HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to be broken or to have a sore. Most genital herpes is caused by HSV-2. A person almost always gets HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection but may not know that they are infected and may not have a visible sore.
HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.
What are the signs and symptoms of genital herpes?
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
Most people diagnosed with a first episode of genital herpes can expect to have several outbreaks (symptomatic recurrences) a year (typically four or five). Over time these recurrences usually decrease in frequency.
What are the complications of genital herpes?
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can cause potentially fatal infections in babies if the mother has sores at the time of delivery. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Worldwide, herpes may play a role in the heterosexual spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
How is genital herpes diagnosed?
The signs and symptoms associated with HSV-2 can vary greatly. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV-1 or HSV-2 infection, may be helpful, although the results are not always clear-cut.
Is there a treatment for herpes?
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication.
How can herpes be prevented?
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if you do not have any symptoms you can still infect your sex partner. Even if there are no symptoms, sex partners of infected persons should be advised that they may become infected. Partners can seek testing to determine if they are already infected with HSV, or are still at risk for acquiring HSV. A positive HSV-2 blood test would mean that they probably have genital herpes; however, a positive HSV-1 blood test means that they have probably been infected with HSV-1, but the infection could be genital or it could be oral.
Where can I get more information?
Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
http://www.cdc.gov/std
Personal health inquiries and information about STDs:
CDC National STD and AIDS Hotlines
1-800-227-8922 or 1-800-342-2437
En Espanol 1-800-344-7432
TTY for the Deaf and Hard of Hearing 1-800-243-7889
National Herpes Hotline
1-919-361-8488
National Herpes Resource Center
http://www.ashastd.org/hrc
herpesnet@ashastd.org
Resources:
CDC National Prevention Information Network (NPIN)
PO Box 6003
Rockville, MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
http://www.cdcnpin.org
E-mail: info@cdcnpin.org
American Social Health Association (ASHA)
PO Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877
http://www.ashastd.org
STD questions: std-hivnet@ashastd.org
Sources
Anderson J, Dahlberg L. 1992. High-risk sexual behavior in the general population. Results from a national survey 1988-90. Sex Transm Dis 19:320-325.
Aral SO, Wasserheit JN. 1995. Interactions among HIV, other sexually transmitted diseases, socioeconomic status, and poverty in women. In: O’Leary A, Jemmott LS, editors. Women at Risk: Issues in the Primary Prevention of AIDS. New York: Plenum Press.
Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002; 51(no. RR-6).
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2002. Atlanta, GA: U.S. Department of Health and Human Service, September 2003.
Fleming DT, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, St. Louis ME. 1997. Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. NEJM 16:1105-1111.
Laumann EO, Gagnon JH, Michael RT, Michaels S. 1994a. The number of partners. In: The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, pp. 174-224.
Laumann EO, Gagnon JH, Michael RT, Michaels S. 1994b. Sexual networks. In: The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, pp. 225-268.
Moran JS, Aral SO, Jenkins WC, Peterman TA, Alexander ER. 1989. The impact of sexually transmitted diseases on minority populations in the United States. Public Health Rep 104:560-565.
Seidman SN, Aral SO. 1992. Race differentials in STD transmission. Am J Public Health (letter) 82:1297.
Source: CDC - National Center for HIV, STD and TB Prevention
December 2003
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