Herpes viruses inside a cell. Image: CDC

In the most recent Planned Parenthood annual report, a Tucson mother describes her daughter’s mysterious ailment, which stumped doctors at the hospital. Her symptoms included an itchy, tender genital area with painful lesions — but the physicians who “pored over her poor vulva” decided it was nothing to worry about and sent her home. A few days later, though, she called her mother in the middle of the night, sobbing, her condition now worse. “There were lesions, pustules, and the area was deep red,” her mother wrote. So this time, she called the experts: Planned Parenthood.

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If you have symptoms, get checked out! An accurate diagnosis is more likely when symptoms are present.

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The condition wasn’t nothing — it was genital herpes, and the mother praised Planned Parenthood for “spot[ting] something other pros missed.” Indeed, sexual and reproductive health is what we do — day in and day out! Whether you’re young or old, sexually active or celibate, insured or paying out of pocket or eligible for sliding-scale fees, we’re here to share our expertise with you.

The word “herpes” comes from an ancient Greek word that means “to creep,” after the “creeping” nature of skin lesions that might spread across areas of one’s body. We now know that the herpes simplex virus can “creep” up and down nerves, retreating to nerve cells to go dormant and returning back to the surface of the skin to cause symptoms or “shed” new virus particles. (Like a cat sheds fur, so too can people shed viruses.)

Herpes is caused by a virus called herpes simplex virus, or HSV, and there are two types — HSV-1 and HSV-2. Both virus types can infect your mouth and lip area as well as your genitals. HSV is a member of the Herpesviridae family, which boasts many other well-known herpesviruses, such as varicella zoster virus, which causes chickenpox and shingles; and Epstein-Barr virus, which causes infectious mononucleosis as well as other maladies. The Herpesviridae family is huge, with at least 100 members infecting mammals, birds, reptiles, bony fish, amphibians, and oysters. Even dinosaurs are thought to have been infected by herpesviruses!

Worldwide, 90 percent of humans have been infected with at least one HSV type. While HSV-1 usually infects the facial region, HSV-2 is most commonly associated with genital herpes. HSV-2 prevalence varies from country to country, but in the United States and most of Europe it’s around 20 to 30 percent of the population, making it a very common virus indeed.

Here’s the scoop on genital herpes, in a nutshell:

• It is transmitted by vaginal, anal, or oral sex — as well as by skin-to-skin contact, for example by rubbing genitals together.
• Symptoms might include blisters, itching, pain, and open sores in the genital region. A new infection could have additional symptoms, including fever, chills, and a flu-like feeling.
• If symptoms show up, they usually do so within 2 to 20 days after infection, but it’s more common not to have symptoms at all — in most cases, symptoms are unnoticeable or completely absent!
• It’s also possible not to have symptoms upon infection, but to have an “outbreak” after an infection has already been established — possibly making it difficult to know from whom you acquired the infection.
• After your first outbreak, it is possible to have “recurrences” — further outbreaks — but they are usually not as severe as the first.
• A herpes infection is with you for life and cannot be cured.
• If you’re exhibiting symptoms, get checked out! An accurate diagnosis is the easiest to obtain when a health care provider can do a physical examination and send samples to a lab. Blood tests can’t distinguish between oral and genital herpes infections.
• There are medications that can relieve or prevent herpes symptoms.
• There are measures you can take to help prevent transmitting the virus to your partner(s).

Most people associate genital herpes with the symptoms of an outbreak. The most easily recognized symptom is a cluster of blisters in the genital or rectal area. However, symptoms can also be quite mild, and go unnoticed by a sufferer, or they might be nonspecific, meaning that the sufferer doesn’t connect them to a herpes outbreak. These symptoms include vaginal discharge, rashes, pain, or itching.

HSV-1 and Genital Herpes

Although HSV-1 is most commonly associated with cold sores around the mouth,  genital HSV-1 infections are more common nowadays, possibly due to the increasing prevalence of unprotected oral sex. If you’re already infected with HSV-1 in the facial region, you’re less likely to have severe symptoms if you subsequently acquire an HSV-1 infection in the genital region. (Unfortunately, just because you get cold sores around your mouth doesn’t mean you’re immune to a below-the-belt HSV-1 infection.)

After a new genital HSV-1 infection, the median duration until a recurrence is 195 days for females and 567 days for males. However, recurrences only strike 19 percent of people with HSV-1 infections in their genitals. Most people with genital HSV-1 infections don’t have to worry about outbreaks!

HSV-2 and Genital Herpes

In the United States, the mean age for acquiring an HSV-2 infection is 24. Women are more likely to acquire HSV-2 infections, both because they are more anatomically vulnerable and also because they’re more likely to be with an older male partner who himself has had more past sexual partners.

When symptoms do appear, they’re usually at their worst when an infection is new (“primary infection”). And, regardless of whether or not symptoms appear, viral shedding lasts longer during a primary infection than it does during a recurrence. Among those infected with symptomatic HSV-2, 1 out of 3 never experiences a recurrence after the first outbreak, and another 1 out of 3 only has one or two recurrences per year. Recurrences can be triggered by many things, including stress, menstruation, or sexual intercourse.

Genital HSV-2 symptoms tend to be more severe than symptoms associated with a genital infection of HSV-1. During an outbreak, cells that are infected with the virus swell in size and then burst, releasing virus-filled fluid that becomes pus. Up to 100 lesions can be detected in the genital area during an outbreak, which can last up to three weeks. The more severe the first outbreak is, the more likely you are to have recurrences. In the first year, recurrences occur a median of four times for females and five times for males. An unlucky minority — 14 percent females and 26 percent of males — will have more than 10 recurrences during the first year. After the first year, outbreaks generally decrease in frequency, and symptoms tend to be mild and resolve in 8 to 10 days.

You can find more information about herpes at Planned Parenthood’s website. If you are concerned that you might have herpes, you can get tested at a Planned Parenthood health center. The test for herpes involves either a blood test (if one is asymptomatic) or a test of fluid taken from a suspected herpes sore.

Click here to check out other installments of our monthly STD Awareness series!