Genital herpes is a common sexually transmitted disease that affects both men and women. Features of genital herpes include pain, itching and sores in your genital area.

The cause of genital herpes is a type of herpes simplex virus (HSV), which enters your body through small breaks in your skin or mucous membranes. Sexual contact is the primary way that the virus spreads.

There's no cure for this recurrent infection, which may cause embarrassment and emotional distress. Having genital herpes is no reason to avoid sex or give up on relationships though. If you or your partner is infected, you can manage the spread of HSV by taking steps to protect yourself and your partner.

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Genital herpes

The majority of people who've been infected with HSV never know they have the disease because they have no signs or symptoms. The signs and symptoms of HSV can be so mild they go unnoticed. The first outbreak is generally the worst, and some people never experience a second outbreak. Other people, however, can experience outbreaks as long as 40 years after the initial outbreak.

When present, genital herpes symptoms may include:

• Small red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal or nearby areas
• Pain or itching around your genital area, buttocks or inner thighs

The initial symptom of genital herpes usually is pain or itching, beginning within a few weeks after exposure to an infected sexual partner. After several days, small red bumps may appear. They then rupture, becoming ulcers that ooze or bleed. Eventually, scabs form and the ulcers heal.

In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs or inside the urethra, the channel inside the penis leading to the bladder.

While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial outbreak, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.

Recurrences
Genital herpes is different for each person. The signs and symptoms may recur for years. Some people experience numerous episodes each year. For many people, however, the outbreaks are less frequent as time passes. Various factors may trigger outbreaks, including:

• Stress
• Menstruation
• Immune system suppression, from medications such as steroids or chemotherapy, or due to infections, such as HIV/AIDS
• Illness
• Surgery
• Friction, such as that caused by vigorous sexual intercourse
• Fatigue

In some cases, the infection can be active and contagious even when lesions aren't present.

When to see a doctor
If you suspect you have genital herpes — or any other sexually transmitted disease — see your doctor.

Two types of herpes simplex virus infections can cause genital herpes:

• HSV type 1 (HSV-1). This is the type that usually causes cold sores or fever blisters around your mouth, though it can be spread to your genital area during oral sex.
• HSV type 2 (HSV-2). This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious whether or not you have an open sore. However, in many people the infection causes no recognized signs or symptoms and can still be spread to a sexual partner.

Because the virus dies quickly outside of the body, it's nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.

In healthy adults, genital herpes generally doesn't cause other serious permanent complications besides the sores. However, sometimes these complications may occur:

• Contracting other STDs. Having genital herpes can increase your risk of transmitting or contracting other sexually transmitted diseases, including the AIDS virus.
• Newborn infection. A mother with open sores can spread the infection to her newborn as the infant passes through the birth canal. Mothers experiencing their first outbreak of herpes at the time of delivery are the most likely to transmit the infection to their babies. Genital herpes may result in brain damage, blindness or death for the newborn.
• Meningitis. In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord.
• Urinary bladder retention. In women, HSV infection can lead to difficulties with the urinary system, such as urine retention.
• Proctitis. In men, HSV infection can lead to inflammation of the lining of the rectum, particularly in men who have sex with men.

If you think you have a sexually transmitted disease, such as genital herpes, make an appointment to see your doctor or health care provider.

Appointments can be brief and there's often a lot of ground to cover, so be well prepared for your appointment. Here's some information on what you can do to get ready and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Some basic questions to ask your doctor include:

• What kinds of tests do I need?
• Should I be tested for other sexually transmitted diseases?
• Should my partner be tested?
• Do I need to abstain from sexual activity during treatment?
• How can I avoid infecting my partner?
• Is there a generic alternative to the medicine you're prescribing me?
• Do you have any brochures or other printed material that I can take with me? What Web sites do you recommend?
• Under what circumstances should I plan for a follow-up visit?

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• Do you have a new sexual partner or multiple partners?
• Do you use condoms?
• When did you first begin experiencing symptoms?
• What are your symptoms?
• Are you experiencing any pelvic pain?
• Do you have any pain while urinating?
• Do you have any sores or unusual discharge?

Your doctor usually can diagnose genital herpes based on a physical exam and the results of certain laboratory tests:

• Viral culture. This test involves taking a tissue sample or scraping of the sores for examination in the laboratory.
• Blood test. This test analyzes a sample of your blood for the presence of HSV antibodies to detect a past herpes infection.
• Polymerase chain reaction (PCR) test. From a blood, tissue or spinal fluid sample, this DNA test can establish the presence of HSV and determine which type of HSV you have.

Because people with herpes commonly have other sexually transmitted diseases (STDs), such as chlamydia, gonorrhea or HIV/AIDS, your doctor will likely examine you for these diseases as well. If you suspect that you previously had a herpes outbreak, a blood test can confirm past exposure to HSV-1 or HSV-2 infection.

Genital herpes treatment includes oral prescription antiviral medications, such as acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex).

There's no cure for genital herpes. But with treatment, you might:

• Help sores heal sooner during an initial outbreak
• Lessen the severity and duration of symptoms in recurrent outbreaks
• Reduce the frequency of recurrences
• Minimize the chance of transmitting the herpes virus to another

Your doctor may recommend that you take the medicine only when you're experiencing symptoms of an outbreak (episodic therapy). Or your doctor may recommend that you take a medicine daily, even when you're not experiencing any signs of an outbreak, to minimize your chances of recurrent outbreaks (suppressive therapy). Suppressive therapy usually is recommended if you experience five or more outbreaks per year. But because these medications have proven very safe and effective, people with even fewer outbreaks per year are opting for daily, suppressive therapy.

Finding out that you have genital herpes may be quite distressing. Among the tumult of emotions, you might feel shock, shame or anger. You may be suspicious or resentful of your partner if you think he or she "gave" you an STD. Or you might be fearful of rejection in your current partner or future partners.

What you're feeling is normal and perfectly valid. But you can cope with your diagnosis of genital herpes in a healthy and effective way. Here's how:

• Communicate with your partner. Be open and honest about your feelings. Trust your partner and believe in what he or she tells you. Don't be too quick to assign blame or accuse.
• Educate yourself. Talk with your doctor or a counselor to learn how to live with the condition and minimize your chances of infecting future partners. Learn about your treatment options so you understand how to best manage outbreaks.
• Join a support group. Look for a group in your area or online so that you can vent feelings and learn from others' experiences.

The suggestions for preventing genital herpes are the same as those for preventing other sexually transmitted diseases. The key is to avoid being infected with HSV, which is highly contagious while lesions are present. The best way to prevent infection is to abstain from sexual activity or to limit sexual contact to only one person who is infection-free. Short of that, you can:

• Use, or have your partner use, a latex condom during each sexual contact
• Limit the number of sex partners
• Avoid intercourse if either partner has an outbreak of herpes in the genital area or anywhere else

Open communication with your partner or potential partner is important.

If you're pregnant, be sure to tell your doctor that you have HSV or, if you're unsure, ask to be tested for HSV. Watch for signs and symptoms of HSV during pregnancy. Your doctor may recommend that you start taking herpes antiviral medications late in pregnancy to try to prevent an outbreak from occurring around the time of delivery. If you're having an outbreak when you go into labor, your doctor will probably suggest a cesarean section to reduce the risk of passing the virus to your baby.