Author By Melissa Tennen
Burning, itching, sores, redness. If you have these symptoms in the genitals, you might have genital herpes. Most people with the disease do not know they have genital herpes, according to a recent study of 36 primary care physicians’ offices in six affluent areas. One-fourth of patients had the disease while only 4 percent reported they did. Join Douglas Fleming, M.D., a lead author of the study and assistant professor in the department of medicine at Robert Wood Johnson Medical School in New Brunswick, N.J., as he tells you what to look for and what you can do.
What is genital herpes?
Douglas Fleming: Herpes type 2 is the type that is caused by herpes simplex virus, commonly known as genital herpes, which often recurs throughout life. Almost everyone who has antibodies for type 2 has symptoms from time to time. It does not have a cure but does have effective treatments to manage and even prevent outbreaks. The great majority of people will “shed” the virus and may transmit it to other people.
The major symptoms of some herpes outbreaks are painful blisters or open sores in the genital area. This is the “classic” case of genital herpes. However, in reality, most outbreaks of genital herpes are not so obvious, and may manifest as itching or irritation in the genital area, discharge, pain with urination, or other symptoms that might be confused with other problems. For example, recurrent bouts of “yeast infections” or “urinary tract infections” may actually be genital herpes outbreaks.
The herpes sores usually disappear within two to three weeks, but the virus remains in the body for life and the lesions may recur from time to time.
Why look at affluent areas for this study?
Fleming: These results break the stereotype of who has a sexually transmitted disease. It tells us that genital herpes can affect anyone, even affluent populations. Most people assume STDs are contracted by low-income people or people engaging in activities that are high-risk. It’s not the case. Genital herpes, and some other STDs as well, are widely distributed in the population.
According to our study, 88 percent of people who are infected don’t know it. A study like ours certainly raises concern that we need to be more vigilant. Not knowing you have genital herpes can raise the risk of transmission.
What are the health risks of untreated genital herpes?
Fleming: Genital herpes can cause significant problems by causing devastating infections in newborns and in people who are immunosuppressed, such as AIDS patients or people with organ transplants. From my standpoint as an epidemiologist, it is very important to note that genital ulcers like those caused by genital herpes can it can make it easier to transmit or acquire HIV infection. So, herpes and HIV infection can work together.
Genital herpes that is active at the time of birth can be fatal to the newborn. If a woman’s physicians know about the infection, the woman can have a C-section to protect the child.
Why isn’t genital herpes identified better?
Fleming: Genital herpes can be mistaken for other problems. Genital herpes will have blisters that break down, and then there can be pain when urinating. For this reason, in women, genital herpes can be misdiagnosed as yeast infections or urinary tract infection. I always tell my medical residents to look for herpes if the patient keeps having recurrent infections, especially if the patient has unexplained symptoms.
The symptoms can be nonspecific. And people don’t think to look in their genital areas. So, when a doctor sees the scratched areas that are red and irritated, the doctor may not think of genital herpes as a possible cause. But doctors have to “think herpes” and do a culture or other test for herpes if genital herpes is to be diagnosed properly.
What are the symptoms of genital herpes?
Fleming: The classic symptom of genital herpes is a group of small, painful blisters in the genital area. However, only a few cases are this “classic.” Usually, a patient will just notice irritation or itchiness, or a little discharge. Men might think it’s a little knick in the skin, a zipper cut. Not everyone has a terrible outbreak. In fact, that’s a relatively rare way for genital herpes to present.
The sores usually disappear in within two or three weeks, but the virus stays in the body for life and lesions may recur from time to time.
How often does someone with the disease have outbreaks?
Fleming: It depends on the person. But usually, about 1 to 10 percent of their days include an outbreak, with viral shedding or symptoms or both. It’s not always possible to know when an outbreak will occur. It might be once a month or once every year.
How much of a problem is this?
Fleming: Our study suggests that genital herpes is a very widespread problem. It’s one of the most common STDs.
How does the virus act in the body?
Fleming: After it causes the classic blisters, the blisters clear up. The virus tracks up to the sensory nerve and lodges in cells near the spine. When the symptoms come back, it means the virus has gone back down the sensory nerve to the genital area from the spine.
Can it just clear up on its own?
Fleming: No. It usually lasts the person’s entire life, though recurrences are variable, as we discussed.
What treatments are available?
Fleming: First, I recommend getting to know what your outbreaks are like. Talk with your physician or health care provider about this. Recognizing an outbreak – and avoiding sex during the outbreak – is the best way to keep from infecting someone else.
There are antiviral medications that are very effective for genital herpes, and with relatively few side effects. They can be used in one of two ways. First, physicians can give a person having an active herpes outbreak an antiviral medication that will shorten the time to healing by a day or two. This can be very helpful, but generally not dramatic.
Antiviral medications can also be used in “suppressive” doses, which means that they are taken every day in order to suppress outbreaks from ever occurring. Used this way, these medications can reduce outbreaks by 80 to 90 percent. That’s a hugely dramatic effect. It cuts both symptomatic outbreaks and also cuts viral shedding that can lead to transmission of herpes to a sexual partner. Of course, the antiviral medications work only as long as the person continues to take them. They do not eradicate the virus from the body.