Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar. Some other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Will I ever have outbreaks again?

If you have been infected by HSV 1 and/or 2, you will probably have symptoms or outbreaks from time to time. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the sores are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it's inactive.

In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it busies itself by making more viruses near the site of the very first infection. That is where new sores usually will appear.

Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time.

After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by feeling a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear.

The frequency and severity of the recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.

How does the doctor diagnose genital herpes?

Because the genital herpes sores may not be visible to the naked eye, a doctor or other health care worker may have to do several laboratory tests to try to prove that any other symptoms are caused by the herpes virus. A person may still have genital herpes, however, even if the laboratory tests don't show the virus in the body.

A blood test cannot show whether a person can infect another person with the herpes virus. A blood test, however, can show if a person has been infected at any time with HSV. There are also newer blood tests that can tell whether a person has been infected with HSV 1 and/or 2.

What is the treatment?

Although there is no cure for genital herpes, your doctor might prescribe one of three medicines to treat it:

• Acyclovir (Zovirax®) treats the first and/or later episodes of genital herpes.
  
  
• Famciclovir (Famvir®) treats later episodes of genital herpes and helps prevent future outbreaks.
  
  
• Valacyclovir (Valtrex®) treats later episodes of genital herpes.

During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people:

• Keep the infected area clean and dry to prevent other infections from developing.
  
  
• Try to avoid touching the sores.
  
  
• Wash your hands after contact with the sores.
  
  
• Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was.

Can genital herpes cause any other problems?

Usually, genital herpes infections do not cause major problems in healthy adults. In some people whose immune systems do not work properly, genital herpes episodes can last a long time and be unusually severe. (The body's immune system fights off foreign invaders such as viruses.)

If a woman has her first episode of genital herpes while she is pregnant, she can pass the virus to her unborn child and may deliver a premature baby. Half of the babies infected with herpes either die or suffer from damage to their nerves. A baby born with herpes can develop serious problems that may affect the brain, the skin, or the eyes. If babies born with herpes are treated immediately with acyclovir, their chances of being healthy are increased. Therefore, if you are pregnant and infected with genital herpes, you should stay in close touch with your doctor before, during, and after your baby is born.

If a pregnant woman has an outbreak and it is not the first one, her baby's risk of being infected during delivery is very low.

If a woman is having an outbreak during labor and delivery and there are herpes lesions in or near the birth canal, the doctor will do a cesarean section to protect the baby. Most women with genital herpes, however, do not have signs of active infection with the virus during this time, and can have a normal delivery.

Is genital herpes worse in a person with AIDS?

Genital herpes, like other genital diseases that produce sores, increases a person's risk of getting HIV, the virus that causes AIDS. Also, prior to better treatments for AIDS, persons with HIV (because of lower protection from their immune systems) had severe herpes outbreaks, which may have helped them pass both genital herpes and HIV infections to others.

How can I protect myself or my sexual partner?

If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using condoms during sexual intercourse may offer some protection from the virus.

Is any research going on?

The National Institute of Allergy and Infectious Diseases (NIAID) supports research on genital herpes and on herpes simplex virus, HSV-1 and HSV-2, the viruses that cause it. Studies are currently under way to develop better treatments for the 67 million people who suffer from genital herpes. While some scientists are carrying out clinical trials to determine the best way to use existing drugs, others are studying the biology of herpes simplex virus. NIAID intramural scientists have identified certain genes and enzymes that the virus needs to survive. They are hopeful that drugs aimed at disrupting these viral targets might lead to the design of more effective therapies.

Meanwhile, other researchers are devising methods to control the virus' spread. Two important means of preventing HSV infection are vaccines and topical microbicides. Several different vaccines are in various stages of development. These include vaccines made from proteins on the HSV cell surface, peptides or chains of amino acids that present important targets to the immune system, and the DNA of the virus itself. Topical microbicides, preparations containing microbe-killing compounds, are also in various stages of development and testing. These include gels, creams, or lotions that a woman could insert into the vagina prior to intercourse to prevent infection in both herself and her partner.

How can I get help if I'm upset about having herpes or having an infected partner?

Genital herpes outbreaks can be distressing, inconvenient, and sometimes painful. Concern about transmitting the disease to others and disruption of sexual relations during outbreaks can affect personal relationships. If you or your partner has genital herpes, you can learn to cope with and treat the disease effectively by getting proper counseling and medicine, and by using preventive measures as mentioned above. Your local or state health department may be able to offer you counseling. In addition, if you have questions and concerns, you can call the American Social Health Association and the Health Advice Company hotlines:

National Herpes Hotline - 919/361-8488 9 a.m. to 7 p.m. Eastern Time, Monday through Friday

Where can I get more written information?

Herpes Resource Center American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
800/230-6039
http://www.ashastd.org

The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
202/863-2518
http://www.acog.org

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, tuberculosis, malaria, autoimmune disorders, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.

Prepared by: Office of Communications and Public Liaison National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda, MD 20892

Public Health Service U.S. Department of Health and Human Services.