Genital Herpes (HSV-2)
What Is Genital Herpes?
Genital herpes is an infection caused by the herpes simplex virus (HSV) that can cause painful blisters and sores in the genital or anal area. Both HSV-1 and HSV-2 can cause genital herpes. HSV-1 is also associated with cold sores around the mouth and can spread to the genital area through oral-genital contact. HSV-2 tends to recur more frequently in the genital area.
How is genital herpes transmitted?
HSV can be transmitted through direct contact with infected skin or mucous membranes, or through vaginal, anal or oral sexual contact. Even when there are no visible sores or blisters, the virus can occasionally be shed from the skin and mucous membranes; a person can therefore transmit it without knowing they are infected.
Condom use can reduce the risk of transmission, but it does not eliminate the risk completely because the virus can also spread from areas of skin not covered by a condom. Avoiding sexual contact when sores, blisters or symptoms that precede an outbreak, such as tingling or burning, are present helps reduce the risk of transmission.
What are the symptoms?
Many people have no symptoms, or their symptoms may be mild and go unnoticed. When symptoms occur, they may include the following in the genital, anal or surrounding areas:
- Small, painful blisters and sores
- Itching, burning or tingling
- Pain when urinating
- Fever, body aches or swollen lymph nodes during the first outbreak
These symptoms can be confused with other skin or genital infections, so a definitive diagnosis based on appearance alone is not always possible.
How is genital herpes diagnosed?
If an active blister or sore is present, a sample is usually taken from the lesion and tested using HSV PCR/NAAT to confirm the diagnosis. Taking the sample while the lesion is new, before it begins to heal, increases the likelihood of detecting the virus. Laboratory testing can distinguish between HSV-1 and HSV-2. If the lesion has healed or there is no viral shedding when the sample is taken, a negative result may not definitively rule out infection.
Blood tests provide different information: Type-specific HSV IgG antibodies indicate that a person may have been exposed to HSV in the past; they do not determine when or from whom the infection was acquired. An HSV-1 IgG result cannot distinguish whether the infection is oral or genital. If recent transmission is suspected, the test may be negative at an early stage because antibodies may not yet have developed. Since low-positive HSV-2 results can be false positives, a doctor should assess whether confirmation is needed. HSV IgM testing is not recommended for diagnosis.
Routine HSV-2 blood testing in people without symptoms is not recommended in most cases; the limitations of the test and the possibility of false-positive results should be considered. The decision to test should be based on symptoms, partner history and clinical assessment.
Can genital herpes be treated?
HSV can remain in the body permanently; current antiviral medicines do not completely eliminate the virus from the body. However, antiviral treatment prescribed by a doctor can reduce the duration and severity of the first outbreak or recurrent outbreaks. Daily suppressive treatment may be considered for frequent recurrences. In some people, this treatment can also reduce the risk of transmission, but it does not eliminate it completely.
Genital herpes during pregnancy
A history of genital herpes or newly developed genital sores and blisters during pregnancy should be discussed with your obstetrician. The risk of transmission to the baby is particularly important when the infection is acquired for the first time in late pregnancy. If active genital lesions or symptoms that precede an outbreak are present at the time of delivery, the doctor will assess the appropriate mode of delivery; a history of herpes does not automatically mean that everyone requires a caesarean section.
When should you see a doctor?
If new blisters, sores, pain or burning develop in the genital area, seek medical assessment for a diagnosis. If an active lesion is present, seeking care promptly so that a sample can be taken may be helpful. If new symptoms develop during pregnancy or herpes is suspected close to delivery, inform your healthcare team without delay.