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What is genital herpes?
Genital herpes is one of the most common sexually transmitted infections. Genital herpes affects 1 in 6 people in the United States. Many people have herpes but do not know it because they never had pain or sores. Genital herpes infections can cause pain, itching, and sores that appear on the skin and near the vagina or anus.
What causes herpes?
Herpes is caused by a virus called herpes simplex virus (HSV). Once you have herpes, the virus is present in your body for the rest of your life. There is no cure or vaccine for HSV. There are 2 types of HSV. Herpes-1 (HSV-1) is commonly found in or around the mouth or lips and is called “cold sores.” Occasionally HSV-1 can also affect the genital area. Herpes-2 (HSV-2) is the most common cause of genital herpes. Either type can be passed through oral, genital, or anal sexual contact.
How is herpes spread?
Herpes is passed through touching or contact with the skin of another person who carries HSV. If you have a herpes sore, you should avoid sexual contact or body contact that would expose another person's skin to the sore. There is a higher chance you will pass the virus if you have sexual contact when open sores are present. Unfortunately, you can also pass the virus through sexual contact even when you have no symptoms or sores.
What does a herpes sore look like?
When you get herpes, the sores will appear 2 to 12 days after you were exposed. You can also get the herpes virus but never have any sores. The sores look like blisters, and they may be very small or as big as one inch across. They can be much more painful than you would expect for their size. The sores may have several small blisters that appear close together with redness around them. You may have pain when you urinate (pee), headaches, muscle aches, and fever when your first herpes sore appears. Anytime you get herpes sores, it is called a herpes outbreak.
What if I continue to have herpes sores after my first outbreak?
Sores that appear after the first time are called recurrent herpes. When recurrent herpes sores appear, you may have a prodromal stage. This means you have tingling, burning, or pain where a sore is likely to appear. The sore normally appears 1 or 2 days after you have the tingling, burning, or pain. Even though some people never get recurrent outbreaks, most people with HSV-2 can expect up to 4 outbreaks the first year. If you have HSV-1, you may have only one outbreak. You are more likely to have recurrent herpes if you have HSV-2 than if you have HSV-1. Usually you have outbreaks less often as the years go by.
How is herpes diagnosed?
The best test to determine if you have herpes is a culture of the sore. A cotton swab is used to collect some of the fluid in the blister or cells on the sore, and this sample is grown in the laboratory. The sores must be fresh. A culture may not grow if the sores are dried out. Herpes is hard to grow in the laboratory, so if your culture comes back negative, you could still have HSV. The other test is a blood test for antibodies for both HSV-1 and HSV-2. This test can be helpful in some situations such as if your cultures are negative or your partner has HSV and you want to be screened for the virus.
Are there medications I can take to help?
Antiviral medicines such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) can be very helpful. You can take them when you start to have signs of an outbreak to make the outbreak last a shorter time or take them regularly to prevent outbreaks. If you have outbreaks often, you might want to take medicine every day to lower the number of outbreaks that you have. Talk to your health care provider about which medicine is best for you. You can also discuss whether taking the medicine everyday or just when symptoms occur is right for you. Acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or sitz baths (soaking in small amounts of warm water) can help relieve your pain and discomfort with an outbreak.
How will genital herpes affect my current or future sexual partner(s)?
It is possible to have a healthy sex life with genital herpes. Being open and honest with your current and/or future partners is very important. Your partner might have HSV, too, even if he or she has no symptoms. Your partner can be tested to see if he or she carries the virus as well. If your partner does not have HSV, you can do many things to prevent that person from getting the virus. Taking antiviral medicine everyday greatly lowers the chance that your partner will get the virus. You should also use a condom every time you have sexual contact. This includes genital, oral, and anal sex. Barrier protection is not perfect, so it is important that you avoid any type of sexual activity if you have a sore or start having signs of an outbreak.
What if I am pregnant and have genital herpes?
The most serious problem is if your baby gets herpes by being exposed to a herpes sore at the time of birth. The chance your baby will get HSV is very low (less than 1%) if you already have herpes before you get pregnant. The chance your baby will get HSV is much higher if you have your first herpes outbreak around the time of birth. You should avoid having sex with a partner who you know or think has herpes during your third trimester (last 3 months) of pregnancy.
Your provider might recommend that you take medicine to prevent a recurrent outbreak as you near your due date. Medicine might be helpful if you have your first outbreak in your third trimester or if you have outbreaks often. Your provider might avoid some labor interventions such as using a fetal scalp electrode (tiny wire used to check fetal heart rate). Cesarean birth may be recommended if you have an active herpes sore or prodromal symptoms such as pain or burning when you go into labor. After birth, you can breastfeed normally unless you have a herpes sore on your breasts.