Genital herpes is a sexually transmitted infection caused mainly by the herpes simplex virus-2 (HSV-2). The virus primarily spreads through sexual contact. About 20% of people between the ages of 14 and 49 have this infection.

After the initial infection, the virus stays dormant in your body and may reactivate several times a year. Certain factors such as sun exposure or fever may trigger the infection.

The most common symptom of genital herpes is herpetic sores, painful blisters in your genital area, which can burst to ooze fluid. But in some cases, it may be possible that you have no symptoms.

However, if you are infected, you can transmit the virus even if you do not have sores.

As of now, there is no cure for genital herpes, but fortunately, medications are available to ease symptoms and lower the risk of transferring the infection. A barrier contraception method, such as condoms, also helps prevent the risk of getting or spreading the genital herpes infection.

What is Genital herpes (HSV -2)

Two main types of herpes simplex virus cause genital herpes:

• HSV-1: Mainly responsible for oral herpes
• HSV-2: Mainly responsible for genital herpes

The herpes virus can enter your body through a break or crack in the skin or mucus membrane, a thin layer of tissue lining the openings such as the mouth, nose, and genitals.

After entering your body, the virus replicates in the cells. From here, they travel to the nerve cells of the pelvis, where they stay dormant. They can be activated by certain triggering factors such as fever and sun exposure.

The virus is mainly present in the:

• Semen
• Saliva
• Vaginal secretions

You can read more about oral herpes in our previous article.

Complications due to HSV -2

Complications associated with genital herpes may include:

• Newborn infection: Infected mothers can transmit the disease to their babies if they are exposed to the virus during the delivery. The virus can cause blindness, brain damage, or death of the newborn.
• Sexually transmitted infections: Being infected with genital herpes increases the risk of catching other sexually transmitted infections such as AIDS.
• Meningitis: Rarely, HSV can cause inflammation of the tissues surrounding the brain and spinal cord.
• Bladder disorders: Sometimes, genital sores can cause inflammation of the urethra. This may cause swelling and closure of the urethra, requiring a catheter to drain the urine.
• Proctitis: Genital herpes may also cause inflammation of the lining of the rectum (proctitis). This is more common in men who have sex with men.

Symptoms

Many people with genital herpes may have no symptoms, which is known as an asymptomatic infection. In cases where symptoms are present, the most common one is blisters or sores in the genital area.

The appearance of a blister or sore is considered as an outbreak. An initial outbreak could occur anytime between 2-30 days

Symptoms in men include blisters on the:

• Scrotum
• Penis
• Buttocks

Symptoms in women include blisters on the:

• Vagina
• Buttocks
• Anus

Common symptoms include:

• Blisters in the mouth and on the face and lips
• Itching or tingling before the appearance of the blisters
• Blisters may break and ooze fluid
• A crust may be formed over the sores
• Swollen lymph nodes
• Body aches, headaches, and fever

In babies, blisters may be found on the

• Body
• Face 
• Genitals

Babies with genital herpes may also have the following complications:

• Brain inflammation
• Blindness
• Death

Genital herpes is manageable in adults but may cause severe complications in the baby. So, it is essential to communicate to your doctor if you have genital herpes and are pregnant. They will take all the precautions to prevent the spread of infection to your baby during delivery. For instance, getting a cesarean section instead of a vaginal delivery.

Risk Factors

Genital herpes can infect anyone regardless of age. The risk depends on your exposure to the virus.

The most common risk factor is having sex without using barrier methods. Other risk factors include:

• Having sex at a younger age
• Have a weakened immune system
• Being female
• Having multiple sex partners
• Having other sexually transmitted infection

Transmission

Genital herpes mainly transmits through sexual contact with an infected person. It is seen that about 20% of sexually active couples have HSV-2.

It can transfer through:

• Anal or vaginal sex with barrier protection such as a condom
• Sharing sex toys

If an infected woman has genital sores during delivery, the virus can infect the baby.

Diagnosis

Your doctor can diagnose herpes by running a physical check of the sores. They may also advise the following test to confirm the diagnosis of genital herpes:

• Polymerase chain reaction (PCR) test: The test uses the DNA in the blood or tissue sample from the spinal fluid or sore. The DNA is tested to confirm the presence of HSV and the type of HSV.
• Viral culture: It involves scraping the sores or a tissue sample for examination in a laboratory. 
• Blood test: It checks your blood for the presence of HSV antibodies to find out a past herpes infection.

Precautions

Precautions for genital herpes are similar to that of other sexually transmitted infections. If you are infected, abstain from sexual intercourse. Limit sexual activity with a single partner who is free from the infection.

You can take the following precautions:

• Avoid sexual intercourse if the partner has an outbreak of herpes in the genital area or any other body parts
• Use a barrier method of contraception such as a condom
• Washing hands thoroughly with soap and water, especially after touching the infected area during an outbreak

Precautions During Pregnancy

If you have genital sores and are pregnant, talk to your doctor. It is best to get tested for HSV-2 if you are not sure if you have one.

In case you turn out to be positive for genital herpes, your doctor will recommend antiviral medicines to prevent an outbreak during the pregnancy. Even if you have an outbreak, your doctor will help with precautions such as getting a C-section to avoid the risk of infection to the baby.

Treatment

While there is no permanent cure for genital herpes, there are various treatment options to manage the symptoms.

Home Remedies

You can try the following at home:

• Squirting water on the blisters to reduce the pain while urinating
• Applying cream on the urethra before urinating, such as those with lidocaine
• Use of aloe vera gel to the sores
• Applying cornstarch to the affected part
• Having a sitz bath
• Bathing in slightly salted water
• Pain reliever medicines such as ibuprofen or acetaminophen
• Dabbing petroleum jelly to the sores
• Avoiding tight clothes to prevent friction with the sores
• Applying an ice pack wrapped in a cloth. Never apply ice directly to the affected area

Medications

The current treatment approach involves managing the symptoms and limiting the number of outbreaks. In many cases, the sores and other symptoms may subside without treatment. But your physician will determine if you need medicine. Initiating treatment within 24 hours significantly lowers the duration of the outbreak. So, medications should be taken at first signs of infection, such as itching and tingling.

If required, you may be prescribed one of the following medications:

• Famciclovir
• Acyclovir
• Valacyclovir

These medicines lower the risk of you transmitting the infection to others. They also reduce the frequency and intensity of symptoms and outbreaks.

The mentioned medicines are available as creams or pills. For severe infections, they can also be administered by injection.

Final Thoughts

Genital herpes is a sexually transmitted disease mainly caused by the herpes simplex virus-2 (HSV-2).  It can be an asymptomatic infection, but when present, the most common symptom is sores or blisters in the genital area.

As the virus can be easily transmitted through sexual contact, avoiding sex during an outbreak and using a barrier method of contraception is crucial to transfer the infection.

To date, there is no cure for this infection, but the symptoms can be managed through home remedies, over-the-counter medicines, and antivirals. Antiviral medications also reduce the frequency of outbreaks or the risk of transferring the infection to others.