Q: Is it possible to have genital herpes without knowing it?
A: Yes. In fact, many people who have genital herpes don’t
realize they have it.
By The Faculty of Harvard Medical School
Q: Is it possible to have genital herpes without knowing it?
A: Yes. In fact, many people who have genital herpes don’t realize they have it. This sexually transmitted disease can cause small, painful sores in the genital area. Some people also have fever, itching, burning and trouble urinating. But these symptoms may be mild or infrequent, or not occur at all. Women sometimes mistake a herpes outbreak for another problem, such as vaginitis (an infection of the lining of the vagina), a urinary tract infection or even hemorrhoids.
Most cases are caused by herpes simplex virus type 2 (HSV-2), but some are caused by HSV-1, which also causes most cases of cold sores. After an initial outbreak, HSV goes into hiding in the nervous system. At some later point, the virus becomes active again, causing another outbreak. It’s not clear exactly what triggers these recurrences, but they may be linked to menstruation, fatigue, stress and illness. Once a person is infected by HSV-1 or HSV-2, the virus remains in the body for the rest of that person’s life. But just because the virus is in the body does not mean it is causing symptoms. For most or all of its life, the virus may be “asleep” and causing no trouble.
About 25 percent of adults are infected with genital herpes (see graphic). The herpes virus can be spread by both sexual intercourse and oral-genital sex. Although transmission occurs most easily when the sores are actually present, a person who has no symptoms can also spread the disease. Any infected person can shed the virus and pass it to a sexual partner at any time.
After a person is first exposed to HSV, symptoms may appear within 2-12 days. Some people have muscle aches, fever and a headache. Up to half of infected people experience symptoms that occur before the initial outbreak or a recurrence. Known as a prodrome, these symptoms may include mild tingling in the genital area or shooting pains in the buttocks, legs and hips.
A typical outbreak begins with swelling, followed after a few days by a small cluster of blisters that break open, spilling fluid onto the skin, leaving often-painful ulcers that eventually crust over and heal. Another possible symptom is difficulty urinating. Some women have genital irritation or fissures (small cuts). The first outbreak, which is often the worst, usually ends within three weeks.
Several medications – acyclovir (Zovirax, generic), famciclovir (Famvir) and valacyclovir (Valtrex) – can shorten a herpes outbreak by a day or two. But this works only if you take them within 24 hours of the first signs of an outbreak. Taken daily, these pills can also reduce the number of recurrences and decrease viral shedding. You can safely continue the daily regimen (known as suppressive therapy) for three or more years, with few side effects. But experts recommend re-evaluating the situation every year, because relationships may change and recurrences become less common and less severe as you get older.
HSV testing isn’t part of the usual screening for sexually transmitted diseases. Your clinician will decide about testing based on your history and symptoms. If you have symptoms that suggest HSV, she or he can take a swab of an active sore and send it to a lab for a viral culture, although this test doesn’t always confirm the presence of HSV. A more reliable but more expensive test is PCR (polymerase chain reaction). If you don’t have symptoms, but want to know if you’ve been exposed to HSV, a blood test will indicate if you have antibodies to it.
Genital herpes doesn’t cause any serious or long-term problems in healthy adults. But pregnant women infected with genital herpes need to be cautious because they may pass the infection to their babies during delivery. In newborns, HSV-2 infections can lead to severe disabilities or even death. The highest risk is from a first outbreak of genital herpes in the mother around the time of delivery. A cesarean section can greatly reduce the risk, but that’s recommended only if you have open sores during labor. Clinicians often recommend that a pregnant woman who has had recurrent herpes take an antiviral drug as she gets closer to term to prevent an outbreak.
If either you or your partner has the virus (and the other doesn’t), avoid any kind of sexual activity during outbreaks. Condoms can protect against genital-to-genital exposure to the virus, but they don’t prevent skin-to-skin contact with viral-shedding sores. Always use condoms during sexual intercourse if only one of you is infected.
For some people with herpes, the most troubling aspect of having a lifelong infection with a sexually transmitted disease is the shame. If you’re feeling distressed, ask your clinician for a referral to a therapist or counselor.
Submit questions to the Harvard Medical School Adviser at www.health.harvard.edu/adviser. Unfortunately, personal responses are not possible.
