Because of the high prevalence of genital herpes among adult women, all women should have some understanding of this illness. Estimates indicate about 1 in 5 adult women have genital herpes. At least half of those who are infected have no symptoms and are completely unaware that they carry this virus. While contacting the virus has little impact on many women, a first outbreak can cause significant illness for some. Recurrent episodes may be painful and stressful. The infection is contagious, and can be a serious and sometimes fatal illness in a newborn.
For these reasons, having some basic facts about herpes infection is valuable for all and—in the experience of my practice—very reassuring to those who have been exposed to the virus.
Genital herpes is caused by the herpes-simplex virus (HSV). HSV exists as type 1 (HSV-1) or type 2 (HSV-2). The most common HSV infection, the common cold sore (oral herpes), is caused by HSV-1. While HSV-2 rarely causes an oral infection, both HSV-1 and HSV-2 can cause genital infections. Both can also cause infections in the newborn infant. HSV infection is passed from person to person by direct contact of the virus with the mucosa or broken skin. Mucosa refers to the mucous membranes that line the mouth, lips, eyelids, genital area, and anus. The incubation period after contact is 2 to 12 days.
The first illness may cause painful skin lesions (small blisters) on the mouth or genital skin depending on the site of exposure. Remember, however, that half of infected persons have no recognizable symptoms. Others can be very ill with painful lesions as well as general symptoms of headache, fever, muscle aches, and painful urination. After the first infection, the virus remains in sensory nerve cells for life. The latent virus (not active) may reactivate, travel down the nerve to the site of the first infection (genital skin or mouth) and cause skin lesions to return. These later outbreaks are usually much milder than the first episode.
Genital ulcers can be tested for the presence of HSV-1 or HSV-2. Blood tests can show whether someone has antibodies (infection-fighting cells) against HSV-1 or HSV-2. If a genital ulcer tests positive for either virus the diagnosis of genital herpes is confirmed. The presence of antibodies to HSV-2 in the blood can also confirm genital herpes. However, because so many individuals have been exposed to the cold sore virus (HSV-1), a person who has antibodies for HSV-1 cannot know she has genital herpes unless a genital ulcer tested positive for HSV-1.
Medications are available to treat both the first infection and recurrences. With medication, the period of illness is shorter. Some patients with frequent recurrences may take medication to reduce the frequency of these episodes. HSV-1 genital herpes has very few recurrences, so it is helpful to distinguish between the two viruses.
A woman who is pregnant or considering pregnancy should understand a few additional facts. If a woman is exposed to genital herpes late in pregnancy and has a vaginal delivery with active herpes lesions present on the genital skin, her newborn has a high risk of developing a life-threatening herpes infection. Fortunately, the much more common situation involves a woman who has had previous genital herpes and—at the time of her delivery—has recurrent lesions. The antibodies she already has against the virus give her baby protection as well. If a mother with a history of genital herpes has no lesions at the time of her delivery, chances that her baby will be affected are remote (1 in 5000). Even if a recurrent genital herpes lesion is present when she delivers vaginally, there is only about a 2% chance her newborn will have an infection. We do recommend that a woman who has had a previous genital herpes infection take medication for the last 4 to 5 weeks of her pregnancy to suppress the virus. In the rare case that a recurrent genital herpes lesion is present during labor, we recommend a cesarean delivery (C-section). In this case the risk to the baby is again remote.
This is a long story to tell young women in distress over a diagnosis of genital herpes. But the information should reassure her that with these standard, simple precautions the chance that the HSV virus will have any impact on her future pregnancies is remote. It is vital that a woman notify her obstetrician if she or her partner has a history of genital herpes so the appropriate strategy to protect the newborn can be implemented.
Finally, we recognize that a diagnosis of genital herpes will be distressing to any woman. Understanding the condition and realizing that it is a common illness similar to a cold sore will avoid self-esteem issues. Recognize that it is contagious when a lesion is present and possibly at other times as well. Disclosure to a partner is an important consideration. The virus spreads so easily because it can be spread when it is not visible. Continuous use of suppressive medication will reduce (but not eliminate) the risk of passing the virus to a partner who is negative. Above all, keep your doctor informed. Your doctor can guide you toward making sure this common condition has little impact on your life.