Genital herpes is one of the most commonly sexually transmitted diseases in the United States. Because genital herpes is not a reportable infection, I don’t feel there’s adequate statistics on how many people are infected in the U.S., other than to say a lot of people have it. People often identify genital herpes as the STD that causes outbreaks in the form of sores or lesions, and flu-like symptoms.
There are two strains of the Herpes Simplex Virus, referred to as HSV-1 and HSV-2. HSV-1 is a much gentler strain in terms of how it presents itself. It is most commonly characterized by cold-sore type lesions usually in or around the mouth and is not transmitted sexually. HSV-1 is usually transmitted through casual contact such as sharing food utensils, and children are often prone to it for this reason. Both strains of the HSV are associated with the immune system. In other words, the more immune suppressed, or simply run down you are, the more likely an outbreak.
Genital herpes, or HSV-2 is transmitted sexually, and is characterized by outbreaks that are more severe and longer lasting. Like HSV-1, the symptoms come in the form of sores or lesions, at the site of the exposure and are usually accompanied by some fairly intense flu-like symptoms. Thus, with genital herpes, the sores are most likely to arise in the genital area and they are quite painful. They often last up to three weeks. More and more often, I see patients with outbreaks of HSV-2 in the mouth. As you can imagine, this is most likely being transmitted during oral sex. Performing oral sex on someone who is infected with HSV-2 can certainly transmit orally.
Many people who have endured repeated outbreaks of genital herpes will describe a “tingling” feeling prior to the onset of symptoms, such as lesions. People who are infected are always shedding the virus and can transmit to a sexual partner even when they are not experiencing an outbreak. People are more infectious when they are experiencing an outbreak. People can have the virus and not experience any symptoms for years or may even never experience an outbreak, yet they are still passing on the virus. The first outbreak is usually the most severe and lasts longer than usual.
Testing can be a bit tricky and this is when people often get confused. There are two ways to test for HSV and timing is important. If you are in an outbreak situation, with sores or lesions, the area can be swabbed and cultured in order to identify a positive. If the sore is crusted over at all, there can easily be a false negative. The other option is simply a blood test. It’s important that you request a test that can differentiate between HSV-1 and HSV-2. If you have a sore and you take a general HSV blood test, you could simply have HSV-1 but the genital sore could be attributed to another infection. Unfortunately, the blood test has a window that can last up to two months. Thus, if you have sores and you think you were exposed and your blood test was negative, it’s recommended you repeat the test in two months in order to make sure infection was not missed.
There is still no cure for genital herpes. And remember, once infected you can always pass this little friend on to your sexual partners, even in the absence of an outbreak. There is medication available, often referred to as suppressive therapy that when taken either at the onset of an outbreak or taken on a regular basis, will often reduce the severity and the length of the outbreak. These medications are most commonly known as Acyclovir or Valtrex. Recent research has shown that when people take the suppressive medications on a regular basis, the frequency of outbreak is reduced. Since HSV-2 is closely tied to the immune system and is a zoster virus, maintaining optimal health is a natural suppressive action that is known to reduce outbreaks among those who are infected.
For details about genital herpes, visit the Centers for Disease Control and Prevention website at cdc.gov/herpes.