What is genital herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 or type 2.

How common is genital herpes?

Genital herpes infection is prevalent in the United States. The CDC estimates that approximately 776,000 new herpes infections occur annually. Nationwide, 15.5% of individuals aged 14 to 49 are infected with HSV-2. The actual prevalence of genital herpes is likely higher than 15.5% due to an increasing number of infections caused by HSV-1. Typically acquired in childhood, the decline in HSV-1 infection rates over recent decades may have made people more susceptible to genital herpes from this strain.

HSV-2 infection is more common in women than in men, with rates of 20.3% for women compared to 10.6% for men in the 14 to 49 age group. The virus is more easily transmitted from men to women than vice versa. Additionally, HSV-2 is more prevalent among non-Hispanic blacks (41.8%) than non-Hispanic whites (11.3%), a disparity that persists even among individuals with similar numbers of lifetime sexual partners. For instance, among those with 2–4 lifetime partners, the prevalence of HSV-2 is still higher in non-Hispanic blacks (34.3%) compared to non-Hispanic whites (9.1%) or Mexican Americans (13%). Most individuals infected with the virus are unaware of their status, with an estimated 87.4% of 14–49-year-olds with HSV-2 in the U.S. having never received a clinical diagnosis.

How do people get genital herpes?

Infections are transmitted through contact with lesions, mucosal surfaces, genital secretions, or oral secretions. HSV-1 and HSV-2 can also be shed from skin that looks normal. Generally, a person can only get an HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission most commonly occurs from an infected partner who does not have visible sores and who may not know that he or she is infected. In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10% of days, and on most of those days, the person has no signs or symptoms.

What are the symptoms of genital herpes?

Most people infected with HSV-1 or HSV-2 are asymptomatic or experience very mild symptoms that often go unnoticed or are mistaken for another skin condition. Consequently, 87.4% of those infected remain unaware of their status. When symptoms do occur, they typically manifest as one or more vesicles on or around the genitals, rectum, or mouth (oral herpes). The average incubation period after exposure is about four days, with a range of two to twelve days. These vesicles can rupture, leading to painful ulcers that may take two to four weeks to heal. This occurrence is referred to as an "outbreak" or episode.

The clinical manifestations of genital herpes vary between the initial and recurrent outbreaks of HSV. The first outbreak often involves a longer duration of herpetic lesions, increased viral shedding (which raises the likelihood of transmission), and systemic symptoms such as fever, body aches, swollen lymph nodes, or headaches.

Recurrent outbreaks of genital herpes are common during the first year following infection. Approximately half of the patients who recognize recurrences report prodromal symptoms, such as mild tingling or shooting pains in the legs, hips, or buttocks, occurring hours to days before the appearance of herpetic lesions. Symptoms during recurrent outbreaks are generally shorter in duration and less severe than those of the initial outbreak. While the infection can persist in the body indefinitely, the frequency of outbreaks usually decreases over time. Additionally, recurrences and subclinical shedding are much less frequent for genital HSV-1 infections compared to genital HSV-2 infections.

A herpes infection cannot be cured. Once infected with HSV, the virus remains in the body for life, "hiding" in specific nerve cells and leading to recurrent outbreaks of sores in some individuals. These recurring infections can be triggered by factors such as stress, fatigue, sunlight, or other illnesses like a cold or flu. While medication can alleviate symptoms and reduce the duration of outbreaks, it cannot eliminate the infection.

What are the complications of genital herpes?

Genital herpes can lead to painful genital ulcers that may be severe and persistent in individuals with suppressed immune systems, such as those with HIV. Both HSV-1 and HSV-2 can also cause rare but serious complications, including blindness, encephalitis (inflammation of the brain), and aseptic meningitis (inflammation of the membranes surrounding the brain). Additionally, extragenital lesions may develop in areas such as the buttocks, groin, thighs, fingers, or eyes during the infection.

Individuals diagnosed with genital herpes often have concerns about its effects on their overall health, sex life, and relationships. There can be significant feelings of embarrassment, shame, and stigma associated with a herpes diagnosis, which can greatly impact a patient's relationships. Clinicians can help address these concerns by encouraging patients to understand that, while herpes is not curable, it is a manageable condition. Three key steps providers can take for newly diagnosed patients include offering information, providing support resources, and helping them explore their options, as a genital herpes diagnosis can influence perceptions of existing or future sexual relationships.

Window Period of Genital Herpes

Duration:

• The window period for genital herpes typically ranges from 2 to 12 days after exposure, with most people showing symptoms within an average of 4 days.
• However, some individuals may remain asymptomatic and not show visible signs of infection.

HIV/AIDS

What is the link between genital herpes and HIV?

Genital ulcerative disease caused by herpes increases the risk of transmitting and acquiring HIV during sexual activity. When genital herpes is present, the risk of contracting HIV may rise by 2 to 4 times if exposed to the virus. Ulcers or breaks in the skin or mucous membranes (such as those lining the mouth, vagina, and rectum) from a herpes infection can compromise the protective barrier normally offered by these tissues against infections, including HIV. Herpetic genital ulcers are prone to bleeding, and contact with the mouth, vagina, or rectum during sex can further elevate the risk of HIV transmission.

How does genital herpes affect a pregnant woman and her baby?

Neonatal herpes is one of the most severe complications associated with genital herpes. Healthcare providers should inquire about any history of genital herpes in all pregnant women. The virus can be transmitted from mother to child during pregnancy, childbirth, or shortly after birth, potentially leading to a life-threatening neonatal herpes infection. The risk of perinatal transmission is greater during the first outbreak than during recurrent outbreaks, so it is crucial for women to avoid contracting herpes while pregnant. Women should be advised to refrain from intercourse during the third trimester with partners known or suspected to have genital herpes.

A woman with genital herpes may be prescribed antiviral medication starting at 36 weeks of gestation and continuing through delivery to help minimize the risk of a recurrent outbreak. Routine screening for HSV in pregnant women is not recommended. However, upon the onset of labor, all women should be thoroughly examined and asked about any prodromal symptoms or herpetic lesions. If herpes symptoms are present, a cesarean delivery is advised to prevent HSV transmission to the newborn.

How is genital herpes diagnosed?

The preferred tests for patients with active genital ulcers caused by HSV include viral culture and polymerase chain reaction (PCR) for detecting HSV DNA. Viral culture involves collecting a sample from the sore, and after viral growth is observed, specific cell staining is used to differentiate between HSV-1 and HSV-2. However, culture sensitivity is low, particularly for recurrent lesions, and decreases as lesions heal. PCR is more sensitive and provides quicker, more accurate results, making it increasingly popular. Since viral shedding is intermittent, a negative culture or PCR result does not rule out HSV infection. Tzanck preparations are not sensitive or specific and should not be used.

Serologic tests, which are blood tests that detect antibodies to the herpes virus, are also available. Several ELISA-based serologic tests have been FDA-approved for commercial use. However, some older assays do not accurately differentiate between HSV-1 and HSV-2 antibodies, so providers should specifically request type-specific assays when ordering blood tests for their patients. The sensitivity of type-specific serologic tests for HSV-2 ranges from 80% to 98%, and false-negative results may be more common in the early stages of infection. Additionally, false-positive results can occur at low index values and should be confirmed with another test, such as Biokit or the Western Blot. Negative results for HSV-1 should be interpreted with caution, as some ELISA-based serologic tests are not sensitive enough to detect HSV-1 antibodies reliably.

PCR Multiplex DNA Test for 28 Infections 

Our STD PCR Multiplex test offers advanced technology to detect up to 28 infections, including Gonorrhea, Chlamydia, Syphilis, Herpes Simplex, Trichomonas, and Candida strains, all in one test. It can identify infections in various anatomical areas, such as the throat, urethra, anorectal region, vagina, cervix, sperm, and skin lesions. For urethral infections, the Urine PCR is recommended, while the Throat Swab PCR is ideal after oral sex. Anal Swab PCR is advised for unprotected anal sex, and the Vaginal Swab PCR is recommended for vaginal sex, with staff guidance available for all tests.

Contact us at info.bkk@pulse-clinic.com or chat on your preferred platform:

 +66 65 237 1936    @PULSEClinic   PulseClinic

All PULSE Clinics in Thailand provide the most comprehensive PCR Tests for 28 infections to give you peace of mind and fast treatment. 

For the symptomatic patient, testing with both virologic and serologic assays can determine whether it is a new infection or a newly-recognized old infection. A primary infection would be supported by a positive virologic test and a negative serologic test, while the diagnosis of recurrent disease would be supported by positive virologic and serologic test results. 16

CDC does not recommend screening for HSV-1 or HSV-2 in the general population. Several scenarios where type-specific serologic HSV tests may be useful include

• Patients with recurrent genital symptoms or atypical symptoms and negative HSV PCR or culture;
• Patients with a clinical diagnosis of genital herpes but no laboratory confirmation;
• Patients who report having a partner with genital herpes;
• Patients presenting for an STD evaluation (especially those with multiple sex partners);
• Persons with HIV infection; and
• MSM at increased risk for HIV acquisitions

Is there a cure or treatment for herpes?

There is no cure for herpes; however, antiviral medications can help prevent or shorten outbreaks while the person is taking them. Additionally, daily suppressive therapy (the daily use of antiviral medication) can decrease the risk of transmitting the virus to partners.

Several clinical trials have explored vaccines for genital herpes infection, but there is currently no commercially available vaccine that protects it. One trial showed efficacy in women whose partners were infected with HSV-2, but only in those who were not already infected with HSV-1. No efficacy was found in men whose partners had HSV-2. A subsequent trial of the same vaccine demonstrated some protection against genital HSV-1 infection but did not provide any protection against HSV-2.

How can herpes be prevented?

Consistent and correct use of latex condoms can help reduce the risk of genital herpes; however, outbreaks can occur in areas not covered by the condom. The most effective way to prevent the transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact or to engage in a long-term mutually monogamous relationship with a tested and known uninfected partner.

Individuals with herpes should refrain from sexual activity with partners when sores or other symptoms are present. It's important to note that even in the absence of symptoms, a person can still transmit the virus to their partners. Partners of those infected should be informed of their potential risk of infection and encouraged to use condoms to minimize that risk. They can also seek testing to determine if they have HSV.