Genital Herpes: Causes, Stages and Practical Steps to Treat It

Experiencing herpes symptoms for the first time or learning that a sexual partner was diagnosed with genital herpes can bring up a lot of questions. Let’s talk about what genital herpes is, how it affects your body, and what you can do to get relief.

What is genital herpes?

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). The most recent statistics from the World Health Organization (WHO) show that in 2016, an estimated 596–656 million people worldwide had genital herpes, making it one of the most common STIs. There are two strains of the herpes simplex virus, type 1 (HSV-1) and type 2 (HSV-2), both of which can cause a genital herpes infection.

What causes genital herpes?

The herpes virus enters the body through the skin and mucous membranes. It requires direct, close contact to be transmitted from one person to another. This may be through non-sexual contact, such as kissing, or sexual contact, including oral and anal sex.

Our skin is guarded by an outer layer of dead cells known as keratinocytes. Any damage to this layer or the skin underneath allows the herpes virus to enter the body during skin-to-skin contact. Once inside, the herpes virus uses the proteins of our skin cells to make more of the virus’s DNA. This is when we see most of the symptoms, such as ulcerations.

Some of this virus also enters nearby nerve cells, where it can hide from the immune system and cause symptoms again in the future.

Herpes infection is often thought about in terms of cold sores, also known as fever blisters. However, the herpes virus usually infects two main areas of the body — the oral region and the genital region.

What’s the difference between oral and genital herpes?

Oral and genital herpes differ in distinct ways. Knowing the similarities, as well as the differences, can help one understand how they occur and what to expect with future recurrences.

Oral herpesGenital herpes
Common symptomsCold sores (fluid-filled blisters) on the lips and the mouth. Blisters and sores in the genital region, including the buttocks and inner thighs.
Primary infectionUsually, HSV-1.HSV-2 is more common, although infections by HSV-1 are increasing.
Route of transmissionNon-sexual contact, such as kissing and sharing utensils, especially if there is an active lesion. Oral-genital contact can also transmit the virus.Sexual contact, including oral and anal sex.

While HSV-1 and HSV-2 can cause oral and genital herpes, each has a preference for the area of infection. When there is an oral HSV-2 infection or a genital HSV-1 infection, symptoms tend to be less severe, with fewer flare-ups.

HSV-1 infections tend to produce outbreaks once a year, while HSV-2 may cause recurrence up to 4–5 times a year. However, the frequency of outbreaks also depends on many individual factors.

Genital herpes signs and symptoms

Symptoms of herpes can vary significantly. A significant portion of those infected with HSV are asymptomatic and may never experience an outbreak.

Genital herpes typically occurs in a set of stages, but they may differ between individuals.

1. Primary infection

The first outbreak, also known as the primary infection, usually occurs 7–10 days after herpes first enters the body and tends to be the most severe. The severity of symptoms and frequency of outbreaks often decreases over time. Infections with HSV-2 are more likely to be symptomatic and severe than infections with HSV-1.

Symptoms may include:

  • Painful blisters or ulcers that can be alone or in clusters, which eventually dry and scab.
  • Swollen lymph nodes
  • Flu-like symptoms
  • Painful urination
  • Abnormal discharge

Unlike folliculitis and razor burn, genital herpes also occurs in regions where there is no hair growth, such as the glans penis (tip of the penis) and labia minora (inner lips of the vagina). Consulting a healthcare provider can help you get an accurate diagnosis.

2. Latent phase

The cells of our immune systems are attracted to the areas of damage caused by pathogens (bacteria, viruses, and parasites) through signals released by inflammation. During the primary infection, the symptoms result from damage and inflammation to the skin cells, which release the signals to call on the immune system. Our immune system responds by attacking the virus and breaking it down.

To avoid being seen by the immune system, some of the virus enters the nerve cells near the infected skin cells. The virus particles that infect the nerve cells enter a ‘sleeping’ stage, known as the latent phase, during which they don’t cause damage and inflammation.

3. Prodromal stage

During the early stages of a herpes recurrence, some people experience prodromal symptoms, such as tingling, itching, or burning in the region where they usually get an outbreak.

4. Recurrent outbreak

In response to triggers or a weakened immune system, some of the HSV leaves the nerve cells it has been hiding in and infects the surrounding skin cells. In these cells, the virus makes more virus particles, leading to inflammation and irritation. This damage can cause symptoms like blisters and ulcers to reappear.

What testing is available for genital herpes?

The diagnosis of genital herpes is usually clinical, based on the medical history and symptoms. However, several different types of tests are available to diagnose an HSV infection. The test depends on the infection stage and whether there are active symptoms.

  • Nucleic acid amplification tests (NAAT) are the most reliable and are used when there is an active herpes outbreak.
  • Viral culture test
  • Blood antibody test
  • Tzanck smear

Can herpes be cured?

Being diagnosed with genital herpes can seem embarrassing as there is still a lot of misinformation and stigma surrounding the infection. Sex is a normal part of life, and infections with HSV are more common than most people think.

Although, currently, there is no cure for genital herpes, management of symptoms and outbreaks using medications and home remedies is possible. Repeat occurrences also tend to decrease in frequency and severity over time.

What to do if you get an outbreak

It is essential to see your doctor as soon as possible when you first notice symptoms after a primary infection so that they can confirm the diagnosis and prescribe the appropriate treatment.

Medical treatment for genital herpes

Antiviral drugs are the primary pharmacologic treatment for genital herpes, used to treat all stages. Antivirals can reduce the severity and length of an outbreak during the primary infection. They may also be prescribed episodically during recurrent outbreaks.

Although pharmacologic treatment is not always necessary, antivirals prescribed as suppressive therapy can prevent outbreaks. Suppressive treatment is recommended for people who have previously experienced an outbreak and have reduced immune system functioning due to disease or treatment with immunosuppressive therapy. It can also reduce the risk of transmission to sexual partners.

Topical over-the-counter treatments are not recommended as they can cause a delay in healing. However, over-the-counter acetaminophen may be used to manage pain.

Natural remedies for genital herpes

There are steps you can take to help decrease the risk of outbreaks, avoid spreading the virus to other areas of the body, and find symptomatic relief naturally:

  1. Avoid personal triggers to decrease outbreaks (examples include stress, poor diet, and illness).
  2. Warm compresses have been shown to reduce irritation during active oral herpes outbreaks and may bring relief to genital herpes lesions, but will not treat them.
  3. Keep any lesions clean and dry.
  4. Maintain good hand hygiene habits.
  5. Wear cotton underwear and loose-fitted clothing to prevent moisture from being trapped and preventing friction.

While more studies are needed to strengthen the evidence behind alternative topical treatments, there is preliminary research demonstrating support for some natural remedies.

Diet and supplements for genital herpes

You may have heard that supplementing vitamins, such as E and D, or making dietary changes can help with symptoms, but the research is limited.

While rare, any observed personal food triggers should be avoided to decrease the frequency of outbreaks.

In vitro studies have demonstrated the influence of specific amino acids on the life cycle of HSV. These studies show that the replication process requires arginine but is disrupted by lysine. The supplementation of L-lysine, a stable form of the amino acid, and foods with more lysine and less arginine have been proposed as alternative treatments for preventing outbreaks.

However, there is a possible risk of adverse effects and interactions with medications with the use of supplements. The currently available clinical studies provide conflicting information, and more data is needed to establish optimal dosage, effectiveness, and safety.

There are no official recommendations for specific diets or supplements for the management of genital herpes. Ensuring a healthy, balanced diet helps support the immune system to manage the herpes infection naturally. Speak with your physician before starting any supplements or making significant dietary changes.

How do you prevent genital herpes?

The spread of genital herpes can be decreased through the use of safe-sex practices, such as:

  • Use condoms and dental dams
  • Avoid sexual activity during the prodromal phase and active herpes outbreaks
  • Antiviral use by those who have a history of HSV
  • Have an open conversation with your sexual partner about HSV to ensure proper disclosure

Risk factors for the recurrence of genital herpes

After the first infection, the herpes virus can have repeated outbreaks and cause symptoms to return. The health of the immune system and external triggers can influence the frequency with which an outbreak occurs. Common risk factors and triggers include:

  • Illness
  • Lack of proper sleep
  • Stress
  • Poor nutrition
  • Menstrual periods
  • Irritation to the skin through friction or tight clothing

Some people may find that certain foods and behaviors also trigger an outbreak, such as the use of caffeine, alcohol, smoking, and arginine-rich foods (meat, nuts, and chocolate). Keeping a symptom diary can help identify personal triggers.

5 common myths about genital herpes

There are a lot of myths about genital herpes. Here are five of the most common ones:

1. Genital herpes only affects those with multiple sexual partners.

Truth: Anyone sexually active can get genital herpes.

2. You can’t get herpes if your partner doesn’t have visible sores.

Truth: Asymptomatic shedding in those who do not have visible sores or lesions can transmit the virus to another person.

3. A negative STI test means you don’t have herpes.

Truth: Regular STI testing panels do not include tests for herpes. Speak with your physician if you suspect you have an infection with HSV.

4. You can get herpes from toilet seats.

Truth: The risk of infection through exposure to a surface, such as a towel or a toilet seat, is minimal. HSV requires moist environments for the cells to survive and multiply, making it hard for the virus to live for long outside the body.

5. Herpes can be genetically passed down to a fetus.

Truth: Women who are positive for HSV and have an active lesion may expose the baby to the virus during vaginal delivery, causing neonatal herpes. C-sections are used to prevent exposure in the case of an active lesion.

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