Information on Genital Herpes
General Information and Terminology
The herpes virus which causes both genital herpes and
cold sores is the herpes simplex virus, abbreviated HSV.
There are two types of HSV: HSV-1 and HSV-2. Most oral (i.e,
cold sores) and ocular infections are caused by HSV-1; most
genital infections are caused by HSV-2. However, either can
cause infection anywhere on the body.
The other herpes viruses are the Epstein-Barr virus,
which causes mononucleosis, and the varicella-zoster virus
which causes chicken pox and shingles. Apparently shingles
is an adult recurrence of chicken pox!
In addition, there is something ominous (and often
fatal) called herpes encephalitis in which the herpes
simplex virus infects the brain and spinal cord. Genital and
presumably oral, ocular, and other variants of herpes does
NOT lead to herpes encephalitis.
The technical literature refers to infections as being
primary, initial, or recurrent. A primary infection is one
where blood tests don't show antibodies for HSV-1 or HSV-2
at the time that the infection is diagnosed; i.e., one has
not been previously exposed to the type of herpes for which
one will now be treated. An initial infection is one where
no symptoms of infection have previously been noticed, but
blood tests show antibodies for HSV-1 or HSV-2. A recurrent
infection is just that.
What it's doing when it's doing it
"During a ... primary infection of either type 1 or
type 2, herpes simplex will multiply at the original site of
skin exposure to cause the characteristic sores. Also, very
early in the course of the infection, some viruses will
leave the sores to migrate up the sensory nerve that serves
the site of the sores. These viruses become inactive, or
latent, when they reach the nerve cell center, or ganglion.
Even after the sores have healed, the virus remains in the
ganglia to form a permanent reservoir of infection." During
a recurrence, "the virus becomes reactivated, probably
returns down the same nerve, and multiplies on the skin at
or near the site of the original sore". (5)
Symptoms of a primary episode usually appear (if they
appear) 2 to 20 days after exposure, and last an average of
2 to 3 weeks. However, the first noticeable symptoms of
infection can also appear years after exposure.
"...Early symptoms can include a burning sensation,
pain in the legs, buttocks, or genital area, vaginal
discharge, or a feeling of pressure in the abdominal region.
Within a few days, sores (lesions) appear on the penis, on
the vulva or in the vagina, or around the anus. These small,
red bumps, later develop into blisters or painful open
sores. Over a period of days, the sores become crusted and
Symptoms that often accompany a person's first
infection with herpes can include fever, headache, muscle
aches, painful or difficult urination, and swollen glands."
Generally, the first outbreak is the most severe and
most prolonged. Later outbreaks tend to be less severe, and
the intervals between recurrences tend to lengthen over
time. Sometimes there is no recurrence, but usually there
Reading between the lines, it would seem that most HSV
infections are asymptomatic. In one study of over 2,000
individuals only one-fourth of those with antibodies to HSV-
2 had symptoms which by their own description seemed to the
researchers to be symptoms of herpes. In another group, 57%
had type 2 antibodies, but only 3% "gave histories of any
syndrome compatible with genital herpes". (4)
Transmission - symptomatic and asymptomatic
Herpes is definitely contagious from the time that the
first symptoms of an outbreak occur (i.e., before the
blisters appear) until the sores are completely healed. Once
again, the first outbreak is the most virulent; in
recurrences less virus is present in the sores.
"Herpes infections can be transmitted when any part of
person's body directly touches active herpes virus or sores
containing active herpes simplex virus. Mucous membranes,
such as those in the mouth or genital area, are very
susceptible to herpes invasion. Intact skin is usually
resistant, but skin that is broken or damaged - for example
by cuts, abrasions, burns, eczema, or infection - may easily
be infected by herpes simplex virus" (5)
Asymptomatic transmission is also possible, although
there doesn't seem to be any consensus about how common it
is. Various statements on the subject are:
"Anywhere from 1 to 10 percent, depending on the
population studied." (2)
"Three-fourths of source contacts known to patients
with documented primary infections gave no histories of
genital lesions at the time of contact." (4)
Autoinoculation (spreading the infection from one part
of ones own body to another part) is possible, though not
likely. Once again, it is most likely to occur during a
When there is ANY sign of an outbreak, abstain. Any
signs means a suspicion of discomfort, not the appearance of
sores. Abstain until the sores are healed and the scabs have
While the virus is too large to pass through a condom,
in "real-life" situations their protective value is
uncertain." Possibly spermicidal jellies containing
Nonoxynol 9 have some deterrent effect. Oral acyclovir
reduces virus shedding during an outbreak, and so may reduce
risk of transmission, but is not given as a prophylactic.
(It's expensive, it hasn't yet been determined that it
reduces shedding during asymptomatic phases, and the risks
of long term use are not known).
Vaccines have been under development since the early
80's (at least), but apparently it is extremely difficult to
develop a vaccine against herpes which isn't excessively
hard on whatever takes it. NO VACCINE IS CURRENTLY
The discomfort can be relieved to some extent by
keeping the infected area clean and dry, and by wearing
loose fitting clothing. This may also help the sores to heal
faster. Obviously, avoid touching the sores, since they
contain active virus. Aspirin may provide symptomatic
Oral acyclovir reduces the severity and duration of
primary outbreaks, if taken early enough in the course of
the infection. Maintenance dosages reduce the frequency and
duration of recurrences, but once treatment is stopped the
preventative effect stops also. In recurrences, oral
acyclovir reduces the duration of virus shedding, but has
little effect on the symptoms.
The major hazard is to infants at the time of birth.
Also there is a danger of spontaneous abortion associated
with primary infections during pregnancy. Children delivered
vaginally during the course of a herpes episode are at
considerable risk (estimated 40 to 60 percent) of being
infected. Of the infected infants, more than half develop
fatal diseases. In the presence of active infection, the
infant is generally delivered by C-section, which protects
the infant from infection. The infant cannot be infected
through the mothers bloodstream.
For adults herpes (after the first outbreak) is
generally more of a social catastrophe then a physical one,
although infrequently adults are incapacitated by severe
and/or frequent recurrences.
Herpes is EXTREMELY common. Various statistics are:
"Affects an estimated 30 million Americans. Each year
as many as 500,000 new cases are believed to occur." (1)
"The prevalence of HSV infections (Types 1 and 2) in
the general population is high. Estimates vary from 40 to
100 percent based on random sampling of sera for HSV
(1) The Search for Health. The National Institutes of
Health. Bethesda, Maryland. October, 1988
(2) Herpes: Facts and Fallacies. American Journal of
Nursing. June, 1982
(3) Oral Acyclovir for Treatment and Suppression of Genital
Herpes Simplex Virus. Journal of the American Medical
Association. April, 1986
(4) Epidemiology of Genital Herpes Infections in the United
States - The Current Situation. Journal of Reproductive
Medicine. May 1986.
(5) Genital Herpes. U.S. Department of Health and Human
Services. Sept. 1983.
Herpes Resource Foundation. Provides information, therapy,
etc. Contact them at HELP, P.O. Box 100, Palo Alto, CA 94302
or call (415) 328-7710 or (800) 227-8922.
Technical Information Services, Division of Sexually
Transmitted Diseases, Center for Disease Control, Atlanta,
GA, 30333. Written material available upon request.