Genital Herpes (HSV-2)
- Deepi Brar, M.S.
- Posted March 11, 2013
What is it?
Genital herpes is a common sexually-transmitted infection that can cause painful genital sores on both men and women. It's caused by a virus called herpes simplex virus type 2, or HSV-2. An estimated one in five American adults and teens has genital herpes. It's somewhat more common in women than in men. Once you're infected, the virus stays with you, and there's a good chance that the sores will flare up from time to time. The good news is that there are many things you can do to relieve symptoms and prevent outbreaks.
How is it spread?
Most people get genital herpes by having sex with someone who has the virus. It's also possible to get a milder form of genital herpes by receiving oral sex from someone who has cold sores , which are caused by a closely related virus. You can also get oral lesions (mouth sores) from HSV-2.
How can I avoid getting infected?
You can reduce your risk of getting herpes with some simple precautions. For starters, avoid having sex with or sharing personal items with anyone who is having an outbreak, since the risk of infection is highest at that time. If you happen to touch a sore, don't touch anything else and wash the area immediately with soapy water, because that can kill the virus before it infects you.
Use a condom at all other times, because some people with herpes can transmit the virus through their skin if the infection is active even when they don't have any sores. Keep in mind that a condom doesn't cover everything; you can still get herpes from uncovered areas. Also, avoid multiple partners, since this increases the risk that you will come in contact with someone who has the virus. Don't assume you can tell whether your partner has herpes, since many people never have obvious symptoms. Because herpes is at epidemic proportions in the United States, it's safer to assume a new partner may have it and take appropriate steps to protect yourself.
What are the symptoms?
Men can go for years or even decades without ever noticing symptoms of an infection, but women tend to experience symptoms within two to 20 days after picking up the virus. During the first attack, you may have flu-like symptoms such as fever, headache, swollen lymph glands, and muscle aches. You'll also likely notice pain, burning, or tingling around your genitals, thighs, or buttocks, where sores will eventually appear. Small red bumps usually follow, which turn into fluid-filled blisters and break open into shallow pinkish sores. These sores can be very tender and painful. In one to three weeks' time, the sores crust up and disappear.
Later flare-ups tend to be milder, sometimes so mild that you may not even notice them. You'll probably have fewer sores, too, and those you have will heal more quickly. Some people have frequent attacks; others have them only rarely. The average is four per year, and that number tends to go down as time goes by.
I think I might have herpes. What should I do?
See your doctor immediately for a diagnosis. If you are having an outbreak, the doctor can diagnose herpes either through visual inspection or through a sample from the sore. Also, blood tests are available that can more tell whether you've been exposed to the herpes simplex virus. The U.S. Centers for Disease Control and Prevention estimates that most people with herpes are unaware they have it, and this lack of awareness has contributed to the infection reaching epidemic proportions. While you're at the doctor's office, it's a good idea to ask to be tested for other sexually transmitted diseases as well.
If you do have herpes, antiviral drugs can ease your symptoms and shorten attacks when taken within 24-48 hours of exposure. These drugs include Zovirax (acyclovir), along with newer ones such as Famvir (famciclovir) and Valtrex (valacyclovir), which are absorbed more easily and don't have to be taken as often as regular acyclovir. Be sure to let your doctor know if you're pregnant or thinking about becoming pregnant, since it's possible to transmit the virus to your baby during delivery if you have an active infection at the time. Your doctor will want to talk to you about ways to protect your baby's health. You may want to consider having a cesarean delivery, for example.
Is it still safe to have sex?
Herpes doesn't have to mean the end of your sex life; it just means you have to be extra careful with sex and relationships. Make sure you tell your partner about your herpes, so you can discuss things openly. And always use condoms. The herpes medication Valtrex might help prevent the spread of the virus. In a study of 1,500 heterosexual couples, herpes sufferers who took Valtrex were 48 percent less likely to pass the virus on to their partners. To further reduce your risk, the FDA also advises to use condoms.
It's also good to stay attuned to your body so you can decide when it's safe to have sex, since genital herpes tends to come and go. A day or two before an outbreak, for example, the skin in your genital area will often start itching and tingling or feel painful. This is called the prodome stage, and it's caused by nerve endings under the skin signaling that you are on the verge of an outbreak. When you feel this way, you should avoid sexual intercourse and oral sex, because your skin may be shedding the virus. If skin in your genital area is red and tender to the touch, you are in the active phase of the infection, so avoid sex in this period, too. And it goes without saying that if you have genital sores, you should avoid sex until they go away.
How else can I get relief?
- Take warm baths and showers; the heat can inactivate the virus. Dry off with a hair dryer set on low; the warm air will be much more comfortable than an abrasive towel.
- Take a mild pain reliever, such as aspirin or acetaminophen.
- Wear loose-fitting cotton underwear and clothes during outbreaks. Tight-fitting, synthetic garments can cause you to sweat and chafe, which can irritate sensitive sores.
- To dry up sores and speed healing, keep the area clean, cool, and dry. You may want to take a break from heavy exercise during an outbreak, since perspiration and chafing can aggravate symptoms.
- Dab on a water-based zinc ointment. It helps dry out the sores so they can heal faster, and may also boost the immune system.
- Try lemon balm. German studies show that this fragrant herb helps heal sores faster and with less scabbing, especially if it's applied early in an outbreak. Make a tea of dried lemon balm leaves and apply it to sores with a cotton ball.
- Take echinacea. This popular herbal cold remedy doesn't just fight cold viruses. Research on a topical preparation called ViraMedx (viracea) suggests that it's effective against herpes viruses, including strains that are resistant to acyclovir. Take echinacea in capsule or tincture form at the first sign of an outbreak, or dab on a topical formula.
Is there any way to prevent future outbreaks?
- The best thing you can do is keep your immune system as healthy as possible, since outbreaks are most likely to occur when you're run down. Eat a healthful diet, get enough sleep, exercise regularly, and manage your stress with meditation or other methods.
- If you have a weak immune system, talk to your doctor about antiviral drugs. The same ones used to lessen an attack can help prevent recurrences.
- Eat foods high in the amino acid lysine, such as eggs, potatoes, and dairy products, and avoid foods high in another amino acid, arginine, such as peanuts, rice, and chocolate. The herpes virus needs arginine to replicate, and lysine prevents arginine from getting into your bloodstream. Lysine is also sold as a supplement in health food stores; some sufferers say they are able to keep from getting sores if they start taking it when they notice tingling and itching (prodome phase).
- Talk to a close friend, support group, or counselor. Herpes is for life, and it will probably change how you deal with sex and relationships. It's not uncommon to feel anxious, guilty, or lonely, especially when you've just been diagnosed. Talking to someone about it will help you feel better and reduce your stress, which will help you avoid recurrences.
Herpes-Fact-Sheet. National Institute of Allergy and Infectious Diseases, 2010.
American Congress of Obstetrics and Gynecology, 2010. http://www.acog.org/publications/patient_education/bp054.cfm
Centers for Disease Control and Prevention. Genital Herpes. 2007. http://www.cdc.gov/std/Herpes/
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