Herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus (HSV). HSV-type 1 commonly causes fever blisters on the mouth or face (oral herpes), while HSV-type 2 typically affects the genital area (genital herpes). However, both viral types can cause either genital or oral infections. Most of the time, HSV-1 and HSV-2 are inactive, or “silent,” and cause no symptoms, but some infected people have “outbreaks” of blisters and ulcers. Once infected with HSV, people remain infected for life.

How is genital herpes spread?

HSV-1 and HSV-2 are transmitted through direct contact, including kissing, sexual contact (vaginal, oral, or anal sex), or skin-to-skin contact.

Genital herpes can be transmitted with or without the presence of sores or other symptoms. It often is transmitted by people who are unaware that they are infected, or by people who do not recognize that their infection can be transmitted even when they have no symptoms.

How common is genital herpes?

Results of a recent, nationally representative study show that genital herpes infection is common in the United States. Nationwide, 45 million people ages 12 and older, or one out of five of the total adolescent and adult population, is infected with HSV-2.
HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be because male to female transmission is more efficient than female to male transmission. HSV-2 infection is also more common in blacks (45.9%) than in whites (17.6%). Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health such as poverty, access to quality health care, health-care seeking behavior, illicit drug use, and living in communities with high prevalence of STDs.

Since the late 1970s, the number of Americans with genital herpes infection (i.e., prevalence)has increased 30%. Prevalence is increasing most dramatically among young white teens; HSV-2 prevalence among 12- to 19-year-old whites is now five times higher than it was 20 years ago. And young adults ages 20 to 29 are now twice as likely to have HSV-2.

Is genital herpes serious?

HSV-2 usually produces mild symptoms, and most people with HSV-2 infection have no recognized symptoms. However, HSV-2 can cause recurrent painful genital ulcers in many adults, and HSV-2 infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress among people who know they are infected.

In addition, HSV-2 can cause potentially fatal infections in infants if the mother is shedding virus at the time of delivery. It is important that women avoid contracting herpes during pregnancy, because a first episode during pregnancy creates a greater risk of transmission to the newborn. If a woman has active genital herpes at delivery, a cesarean-section delivery is usually performed. Fortunately, infection of an infant is rare among women with HSV-2 infection.

In the United States, HSV-2 may play a major role in the heterosexual spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and can make HIV-infected individuals more infectious.

What happens when someone is infected with genital herpes?

Most people infected with HSV-2 are not aware of their infection. However, if symptoms occur during the primary episode, they can be quite pronounced. The primary episode usually occurs within two weeks after the virus is transmitted, and lesions typically heal within two to four weeks. Other symptoms during the primary episode may include a second crop of lesions, or flu-like symptoms, including fever and swollen glands. However, some individuals with HSV-2 infection may never have lesions, or may have very mild symptoms that they don't even notice or that they mistake for insect bites or a rash.

Most people diagnosed with a primary episode of genital herpes can expect to have several symptomatic recurrences a year (average four or five); these recurrences usually are most noticeable within the first year following the first episode.

How is genital herpes diagnosed?

The signs and symptoms associated with HSV-2 can vary greatly among individuals. Health care providers can diagnose genital herpes by visual inspection, by taking a sample from the sore(s) and by testing it to see if the herpes virus is present.

Is there a cure for herpes?

There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks for whatever period of time the person takes the medication.

How can people protect themselves against infection?

The consistent and correct use of latex condoms is the best protection. However, condoms do not provide complete protection, because a herpes lesion may not be covered by the condom and viral shedding may occur. If you or your partner has genital herpes, it is best to abstain from sex when symptoms are present, and to use latex condoms between outbreaks.

Where can I get more information?

National STD Hotline -- (800) 227-8922
National Herpes Hotline -- (919) 361-8488

References

Anderson J, Dahlberg L. High-risk sexual behavior in the general population. Results from a national survey 1988-90. Sex Transm Dis 1992; 19:320-325.

Aral SO, Wasserheit JN. 1995. Interactions among HIV, other sexually transmitted diseases, socioeconomic status, and poverty in women. In: O’Leary A, Jemmott LS, editors. Women at Risk: Issues in the Primary Prevention of AIDS. New York: Plenum Press.

Fleming DT, McQuillan GM, Johnson RE, Nahmias AJ, Aral SO, Lee FK, St. Louis ME. Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. NEJM 1997; 16:1105-1111.

Laumann EO, Gagnon JH, Michael RT, Michaels S. 1994a. The number of partners. In: The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, pp. 174-224.

Laumann EO, Gagnon JH, Michael RT, Michaels S. 1994b. Sexual networks. In: The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, pp. 225-268.

Moran JS, Aral SO, Jenkins WC, Peterman TA, Alexander ER. 1989. The impact of sexually transmitted diseases on minority populations in the United States. Public Health Rep 104:560-565.

Seidman SN, Aral SO. 1992. Race differentials in STD transmission. Am J Public Health (letter) 82:1297.