What Is Suppressive Therapy
Suppressive therapy involves taking an oral antiviral drug every day for prolonged periods. It interferes with the herpes virus reproductive cycle and so prevents or dramatically reduces the number of recurrences. When recurrences do occur, they are usually less severe and shorter lasting.
If you find the frequency of your outbreaks unacceptable, or if you are finding it difficult to cope emotionally with having recurrences of genital herpes, tell your doctor and discuss the use of suppressive therapy.
Where Does The Herpes Virus Live In The Body
The herpes simplex viruses are latent, meaning they can live in the body without causing symptoms. After the initial infection, the virus gets into the nerve roots and spreads to the sensory nerve ganglia, the junctions where nerves from different parts of the body come together. For the genital area, the ganglia are adjacent to the spinal cord in the lower back. For orofacial herpes , the ganglia are located behind the cheek bone.
Icipants Setting And Sample Collection
The study design is a case series from observational cohort studies of participants seen from 1974 to 2002 at the University of Washington Virology Research Clinic. For this analysis we selected patients with HSV-2 infection documented by serology or viral isolation who had at least one viral culture obtained from the mouth. All patients seen in the clinic had standardised demographic and clinical information obtained. At each clinic visit, a genital examination was done and samples for viral cultures were collected using Dacron swabs from the genital and oral area. The presence of genital lesions was noted by clinician during the visits, or noted in the patient diary in between visits. Patients were requested to return to the clinic at 312 month intervals depending on the protocol in which they were enrolled. A subset of patients participated in home culture protocols, in which the subjects obtained daily swabs for oral as well as genital secretions. The techniques for these studies have been described previously. The patients enrolled in daily home culture after resolution of first episode infection. The oral and genital samples obtained in the clinic, as well as those obtained during home sampling, were obtained without regard to the presence or absence of lesions. Charts of patients with oral symptomatic shedding caused by HSV-2 were reviewed to confirm the presence or absence of lesions in the genital or oral area.
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How Do I Know If I Have Herpes
If a person has an active herpes outbreak with visible sores, a physician or specialist such as a dermatologist can make a diagnosis based on a physical examination. If the physical symptoms alone are not enough, a doctor may take a swab of the sore and send it to a lab for analysis.
If a person does not have physical sores but is concerned, blood tests are available.
People can also take at-home herpes tests, though they should seek a consultation with a doctor to confirm a diagnosis and seek treatment.
When To See A Doctor
Because a person might not have symptoms even if they have herpes, it can be difficult to know when to see a doctor for diagnosis and treatment.
Planned Parenthood recommends that a person see a healthcare professional as soon as they notice sores on or around their genitals. Other STIs, such as syphilis, can have similar symptoms but require different treatment. The American Sexual Health Association also recommends seeing a doctor to get a culture of any lesion or cold sore a person notices.
People may wish to take an at-home STI test before seeing a doctor. However, at-home tests should not replace professional diagnosis and treatment.
- applying aloe vera gel to sores
- applying petroleum jelly to the affected areas
- wearing loose clothing to avoid irritation
- refraining from sexual activity, even with protection, until symptoms have gone
- applying a cream or lotion to the urethra before urinating, such as one that contains lidocaine
Some people find that using ice packs help. However, never apply ice directly to the skin wrap it in a cloth first.
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What Are The Different Types Of Herpes
There are two types of herpes simplex virus: HSV I and HSV II. HSV I commonly causes oral herpes, or cold sores. This virus can show up as an upper respiratory tract infection during early childhood. HSV II is the cause of most cases of genital herpes. However, it is possible for HSV I to cause genital herpes and HSV II to cause oral herpes.
Clinicians cannot tell the difference between the two types by physical examination alone, but there are differences between the two viruses. For example, genital herpes caused by HSV II is much more likely to recur. This diagnosis can be helpful in establishing a health care plan.
Research And Statistics: Who Has Genital Herpes
Its estimated that each year, 776,000 people in the United States get new genital herpes infections. Genital herpes is most often caused by herpes simplex virus type 2 .
According to data from the National Health and Nutrition Examination Survey , the prevalence of HSV-2 was 11.9 percent during 2015 and 2016, a decline of 5.9 percentage points from the years 1999 and 2000.
HSV-2 is more common in women than in men. Its suspected that women are more likely to contract the HSV-2 infection because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex.
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Prevention Of Genital Herpes
Practicing safe sex can reduce the risk of transmitting the virus. This includes being monogamous, or having only one sexual partner, and using condoms or dental dams during sexual encounters.
Herpes can spread from areas of the body not covered by condoms, though. The virus can live on your thighs and buttocks, for instance.
Nonetheless, even though condoms cant work all the time, regular use of condoms can reduce the risk of transmission. For greatest protection, use condoms and dental dams consistently, not just during outbreaks.
Other steps to lower the risk that you will spread herpes to another person include the following:
Im Pregnant How Could Genital Herpes Affect My Baby
If you are pregnant and have genital herpes, prenatal care visits are very important. Some research suggest that a genital herpes infection may lead to miscarriage or make it more likely to deliver your baby too early. You can pass herpes to your unborn child before birth, but it more commonly passes during delivery. This can lead to a deadly infection in your baby . It is important that you avoid getting genital herpes during pregnancy. Tell your healthcare provider if you have ever had a genital herpes diagnosis or symptoms. Also tell them about any possible exposure to genital herpes.
If you have genital herpes, you may need to take anti-herpes medicine towards the end of your pregnancy. This medicine may reduce your risk of having signs or symptoms of genital herpes when you deliver. At the time of delivery, your healthcare provider should carefully examine you for herpes sores. If you have signs or symptoms of genital herpes at delivery, a C-section is likely to occur.
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Recurrence Course Triggers And Timing
Course of Recurrence
Most cases of herpes simplex recur. The site on the body and the type of virus influence how often it comes back. Recurrences of genital herpes are more likely with HSV-2 infection than with HSV-1 infection.
The virus usually takes the following course:
- Prodrome. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itchy skin, pain, or an abnormal tingling sensation at the site of infection. Headache, enlarged lymph glands, and flu-like symptoms may occur. The prodrome, which may last from 2 hours to 2 days, stops when the blisters develop. About 25% of the time, recurrence does not go beyond the prodrome stage.
- Outbreak. Recurrent outbreaks feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. After blisters erupt, they typically heal in 6 to 10 days. Occasionally, the symptoms may not resemble those of the primary episode, but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
Triggers of Recurrence
Herpes outbreaks can be triggered by different factors. They include sunlight, wind, fever, physical injury, surgery, menstruation, suppression of the immune system, and emotional stress. Oral herpes can be triggered within about 3 days of intense dental work, particularly root canal or tooth extraction.
Timing of Recurrences
Is Genital Herpes Related To Shingles
Shingles, also called herpes zoster, is caused by the varicella zoster virus , which causes chickenpox earlier in life. The natural history of varicella zoster infection is similar to genital herpes infection in that VZV also becomes latent in the sensory nerve roots. Later in life the virus may exit, causing shingles.
Recurrences in shingles cause blister lesions in a single area of skin called a dermatome. Shingles is not a sexually transmitted infection and is independent from genital herpes.
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Whats The Difference Between Oral And Genital Herpes
Its an oversimplification to say that HSV-1 causes oral herpes and HSV-2 causes genital herpes, though these are the easiest definitions of each.
HSV-1 is a subtype of the herpes virus that typically causes oral herpes. This is also known as cold sores.
HSV-1 can also cause genital blisters that appear very similar to the genital blisters associated with HSV-2 virus.
Any herpes sore or blister regardless of its subtype can burn, itch, or tingle.
The HSV-2 subtype of the herpes virus causes genital sores, as well as swollen lymph nodes, body aches, and fever.
Although HSV-2 can also cause sores on the face, its much less common than genital sores.
Its difficult to look at a herpes sore and determine whether it was caused by HSV-1 or HSV-2.
To make a diagnosis, a doctor or other healthcare provider would have to take a sample of fluid from a blister lesion or take a small sample of the skin lesion and send it to a lab for testing.
Theres also a blood test available.
Can Genital Herpes Come Back
Yes. Genital herpes symptoms can come and go, but the virus stays inside your body even after all signs of the infection have gone away. The virus becomes “active” from time to time, leading to an outbreak. Some people have outbreaks only once or twice. Other people may have four or five outbreaks within a year. Over time, the outbreaks usually happen less often and are less severe.
Experts do not know what causes the virus to become active. Some women say the virus comes back when they are sick, under stress, out in the sun, or during their period.
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Are These The Only Herpes Viruses
There are actually several other subtypes of herpes viruses that are from the same family as HSV-1 and HSV-2. This family is known as Herpesviridae.
Alternatively, HSV-1 and HSV-2 are also known as human herpesvirus 1 and human herpesvirus 2 , respectively.
The other human herpesviruses include:
- Human herpesvirus 3 : Also known as the varicella zoster virus, this virus causes chickenpox lesions.
- Human herpesvirus 4 : Also known as the Epstein-Barr virus, this virus causes infectious mononucleosis.
- Human herpesvirus 5 : Also known as the cytomegalovirus, this virus causes symptoms such as fatigue and muscle aches.
- Human herpesvirus 6 : This virus can cause a serious illness in infants known as sixth disease, which is also called roseola infantum. The virus causes a high fever and distinctive rash.
- Human herpesvirus 7 : This virus is similar to HHV-6 and can cause some cases of roseola.
- Human herpesvirus 8 : This virus can contribute to a serious illness known as Kaposi sarcoma, which can lead to connective tissue cancer.
Many of these subtypes are contracted in childhood.
What Causes Herpes Zoster
Shingles is caused by the varicella-zoster virus. After a person has had chickenpox, the varicella-zoster virus remains dormant in the body and causes no symptoms. The virus can become reactivated later in life, causing the shingles rash.
Risk factors for developing herpes zoster include:
- Age: more common in adults 50 years of age and older
- People who are immune compromised by:
- Certain cancers
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Myth #: People With Herpes Know That They Have It
Fact: Most people who have oral or genital herpes do not have any symptoms, according to the WHO .
Therefore, a person may not know that they have herpes, which means that they could unintentionally spread it to others.
The WHO state that only of people who have HSV-2 report receiving a diagnosis of genital herpes.
Take Care Of Your Health
If living with herpes will teach you anything, its to pay attention to your body, and thats a great thing. In fact, if you didnt tune into your body and its needs before, its almost kind of a wake-up call. Learning how to manage your diet, exercise, and overall balance will not only lessen your herpes symptoms but improve your mood, sleep, sex, other health issues, and overall satisfaction in life. This could jumpstart you to learn more about safe sex, responsible relationships, nutrition, and health.
Some things you might tune into when managing herpes include which foods to avoid or keep balanced, like limiting your intake of high-arginine foods in favor of ones rich in lysine. This is known to reduce herpes outbreaks. It also helps to be conscious of getting enough sleep and managing stress, and we all need more than that. Stress is the number one outbreak trigger for many people learning how to live with herpes. So relax, get rest, meditate, do yoga, go for a head-clearing bike ride whatever you need.
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Men Vs Women With Herpes
Because of the nature of male and female genitalia, it is easier for herpes to be transmitted to a woman by a man than vice-versa. This is because female genitals have more exposed soft tissue. This also accounts for the slight gender gap in women vs. men with herpes. Approximately one in four American women in has it, while approximately one in five American men does.
Prognosis Of Genital Herpes
Genital herpes can be treated and managed. Baill stresses that for most people who have healthy immune systems, the high-risk times for giving a sex partner genital herpes are during the first outbreak and during later outbreaks of sores.
Without such an outbreak, the viral load is usually not sufficient to infect a normal, healthy partner, she says. Antiviral medication can be effective at controlling the frequency and the severity of genital herpes outbreaks, Baill says.
For some people, though, even the times when no symptoms are present can be risky ones for transmission.
If you have genital herpes and your partner is taking biologic drugs for rheumatoid arthritis or MS or psoriasis, you may need to be extra careful, says Baill. It may take a lower viral load to infect people taking those medications.
In these situations, she says, you may want to take antiviral drugs in an ongoing way to keep your viral load low and protect your partner.
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Do Symptoms Differ Depending On Location
Youll most likely notice similar blisters and prodromal symptoms, no matter what type of the virus you have or where it shows up. The two different types of HSV .
The only major difference, of course, is where you experience symptoms:
- If HSV affects your genitals, you might notice pain or burning during urination.
- If HSV affects your mouth, you might have difficulty eating spicy or acidic foods while you have open sores.
Theres also a slight difference in where oral blisters appear, depending on whether theyre primary or recurrent. During the first episode, blisters may appear on your mouth and lips, but during later episodes, theyre more likely to
What Questions Should I Ask My Healthcare Provider About Itchy Genitals
- Whatâs causing my itchy genitals?
- Whatâs the best treatment?
- Are there any over-the-counter products I should use?
- What can I do at home to manage my itchy genitals?
- How can I prevent itchy genitals?
- What products should I avoid?
A note from Cleveland Clinic
You donât have to just live with itchy genitals. There are effective treatments to relieve or even eliminate your symptoms. See your healthcare provider for help and be sure to take your medications as directed. Itchy genitals shouldnât interfere with your quality of life. Do your best not to scratch so that you donât make your itchiness worse!
Last reviewed by a Cleveland Clinic medical professional on 01/07/2021.
References
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Understanding Herpes With H Hunter Handsfield Md
Herpes expert H. Hunter Handsfield, MD, explains the basics about genital herpes, including the difference between genital HSV-1 and HSV-2 infection, testing options and the importance of knowing virus type, and the three-prong strategy for prevention. See more herpes videos at sexualhealthTV.com.
Have a question about herpes youd like Dr. Handsfield or our other experts to answer? Visit our Ask the Experts page to learn how.
How Painful Is Herpes Simplex
Some people experience very mild genital herpes symptoms or no symptoms at all. Frequently, people infected with the virus don’t even know they have it. However, when it causes symptoms, it can be described as extremely painful. This is especially true for the first outbreak, which is often the worst. Outbreaks are described as aches or pains in or around the genital area or burning, pain, or difficulty urinating. Some people experience discharge from the or .
Oral herpes lesions usually cause tingling and burning just prior to the breakout of the blisters. The blisters themselves can also be painful.
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