What is genital herpes (HSV-2)?

Updated on:
August 11, 2021

Genital herpes is a sexually transmitted infection (STI) caused by the Herpes Simplex Virus (HSV). There are two types of herpes simplex viruses: type 1 (HSV-1) and type 2 (HSV-2).

What are the differences between HSV-1 and HSV-2?

HSV-1 and HSV-2 are within the herpes family of viruses and have only a few genetic differences that result in determining where on the body they are most likely to infect and appear. 

HSV-1 is much more common around your lips, mouth, nose, and/or throat and is often called oral herpes, cold sores, or fever blisters. HSV-2 is much more likely to cause infection and symptoms in or around your genitals (vagina, penis, anus, scrotum, buttocks, inner thighs). HSV-2 is often called genital herpes. However, HSV-1 can also infect the gential area and HSV-2 can also infect around the mouth and nose so the terms oral and genital herpes are better at describing the symptoms rather than the virus.  

Genital herpes is very common!

Most people who have the herpes virus are asymptomatic or have mild symptoms that are mistaken for other skin conditions. 

Those that do have symptoms typically experience them within 2-12 days after exposure. Genital herpes lesions can appear as one or more small blisters on or around the genitals, rectum, and mouth. These lesions or blisters eventually break or burst, leaving ulcers that can take 2-4 weeks to heal. HSV outbreaks can reoccur after the initial outbreak, but how often and how severe these recurrences are is different person to person.

While genital herpes cannot be cured by medication, there are antiviral medications that can reduce the number of future outbreaks, lower transmission risk, and ease symptoms during outbreaks. 

The history of genital herpes & HSV-2

The herpes simplex virus is one of the oldest viral infections known to humankind. References to herpes can be found everywhere from Ancient Rome to Shakespeare. However, only within the last few years have researchers discovered who they now believe to be "patient zero", an ancient hominin (a distant relative of homo sapiens) who likely contracted herpes from chimpanzees between 1.4-3 million years ago! 

The herpes simplex virus (which can cause both genital herpes and oral herpes) belongs to the Herpesvirus family. Other members of the herpes virus family include the herpes zoster virus which causes chickenpox and shingles. 

In the 1960s researchers discovered the two types of herpes simplex viruses, HSV-1 and HSV-2. Experiments with antivirals in that decade were also conducted to help reduce the severity of symptoms. By the early 1980s, the FDA approved the first antiviral medication used to treat herpes, acyclovir, that is still used today along with some newer versions of this drug.

How has our understanding of genital herpes evolved?

This discovery of two types of the HSV virus in 1967 led to the classification of "genital herpes". 

The two types of herpes simplex virus (HSV) are:

  • HSV-1 - usually causes oral infections
  • HSV-2 - usually causes genital infections

Both types of the herpes virus can cause genital herpes. For example, a person with HSV-1 oral herpes (cold sores) can transmit the herpes virus to the genitals of an uninfected sexual partner during oral sex, resulting in genital herpes caused by HSV-1.

Both types of HSV can be transmitted through contact with infected bodily fluid and/or herpetic lesions. It enters the body through the mucous membranes, which are the thin layers of tissues that line the openings of your body (i.e. mouth, nose, throat, genitals, rectum). 

Primary outbreak: 

The primary outbreak is often the most severe, with symptoms usually more severe for women than for men. This initial outbreak occurs within the first few weeks after HSV has infected the body. 

Latent stage: 

In this hidden or dormant stage after the primary outbreak, the virus remains, or "hides" in the nerve cells. There will be no symptoms during this stage, but future outbreaks of lesions (recurrent episodes) can occur.

The herpes virus can be shed from the skin even when there are no symptoms (lesions) present during the latent stage. This is known as asymptomatic viral shedding, and can still infect a sexual partner.

Recurrent infections: 

It is possible for other outbreaks to occur after the primary outbreak. These recurrent episodes happen when the virus travels through the nerves to the skin's surface, causing an outbreak. Many people experience recurrent episodes, but they are usually milder than the primary outbreak. Over time, recurrent episodes typically diminish in frequency and severity. 

These recurrences can be triggered by stress, fatigue, sunlight, tissue trauma, or other infections like a cold or flu. 

Antiviral medications can be used to reduce the severity of outbreaks, both primary and recurrent. 

How prevalent is genital herpes in at-risk groups?

Genital herpes is an extremely common viral infection globally. As many as one in seven Canadians, (about 14%), between the ages of 14-59 may be infected with HSV-2. Of those infected with genital herpes, only about 6% are aware of their status.

Prevalence of genital herpes increases with age from 6% in people aged 14-34, up to 19% in individuals 35+. 

Infection rates are slightly higher in women at 16% than men at 11%. The difference in rates is because females have a higher risk of getting genital herpes from an infected male partner than males have of getting genital herpes from an infected female partner. 

Factors that can increase your risk of contracting genital herpes include:

  • Inconsistent condom use
  • Having a new sexual partner
  • Having multiple sexual partners
  • Having anonymous sexual partners
  • Women and men who have sex with other men experience higher rates of genital herpes.
  • Being a sex worker or having sex with sex workers
  • Being a young adult
  • Drug use
  • Lower socioeconomic status
  • Experiencing violence and/or discrimination
  • Experiencing mental health issues
  • Having previously contracted other STIs

Genital herpes myths

MYTH - You will know you have genital herpes because you'll show symptoms.

Many people infected with genital herpes will not show or experience any symptoms. Sometimes symptoms may appear similar to another skin condition. The only way to know for sure if you have genital herpes is to get tested and diagnosed by a healthcare provider. 

MYTH - Genital herpes can only be transmitted when you have visible lesions or blisters.

While HSV-1 and HSV-2 are more easily transmitted when there are lesions present, transmission can still occur even when there are no lesions visible. 

Because the herpes virus can be shed from the skin even when there are no symptoms (lesions) present (asymptomatic viral shedding), sexual partners can become infected at any time.

MYTH - You can’t transmit genital herpes once you take antivirals. 

While antiviral therapy can help reduce the risk of transmitting genital herpes, it can still be transmitted to sexual partners.  

MYTH - Genital herpes can be permanently cured.

Genital herpes cannot be cured with medication, but it can be managed with treatment! Antiviral medications can help reduce the frequency, severity, and duration of outbreaks. Over time, outbreaks typically occur less frequently and with less severity as your body gets better at recognizing the infection. 

MYTH - Once you've had an initial genital herpes outbreak you won't get one again.

Some individuals with genital herpes may experience no outbreak of lesions or may only experience one lesion outbreak in their lifetime. 

However, genital herpes outbreaks can continue to occur after the primary outbreak. Generally, the number and severity of outbreaks often diminish over time. Antiviral medications can also help reduce the frequency and severity of outbreaks. 

MYTH - STI testing will catch genital herpes. 

Routine STI screening does not test for genital herpes. The best way to diagnose it is to see a doctor, especially when symptoms are present so that a special type of swab can test for the genetic material of HSV-1 and HSV-2. 

How is genital herpes transmitted?

Transmission of genital herpes occurs through skin-to-skin contact. The herpes simplex virus (HSV) enters the body through mucous membranes (i.e. throat, vagina, rectum) after coming into contact with herpes lesions or infected fluid. This typically occurs via contact with a partner's infected oral or genital area. 

HSV-1 and HSV-2 can be found in bodily fluids like saliva, semen, and vaginal secretions. Contact with these fluids can result in transmission. 

Transmission may occur even when an infected partner has no outward symptoms or lesions.

Condomless vaginal, anal, and oral sex are all considered the at-risk behaviours for genital herpes transmission. 

Additionally:

  • HSV-1 typically infects the oral region (mouth, lips), but can also infect the genitals. 
  • An oral HSV-1 infection is most often transmitted through kissing.
  • HSV-1 can spread from the mouth to the genitals through oral sex. 
  • Genital herpes can be transmitted through direct skin-to-skin contact with an HSV lesion or sore. 
  • Performing oral sex on someone that is infected with genital herpes can transmit the infection to your throat and/or mouth.
  • If your partner has an oral herpes infection and they perform oral sex on you, they can transmit the herpes virus to your genitals or rectum.
  • Sharing of sex toys when infected fluids or lesions come into contact with the body can transmit HSV to the mucous membranes that come into contact with them (i.e. genitals, mouth/throat, eyes, rectum).
  • Performing hand jobs or finger stimulation of the vagina or anus if infected fluids or lesions come into contact with the hand can transmit the HSV to mucous membranes the hand then comes into contact with (i.e. genitals, mouth/throat, eyes, rectum).
  • Neonatal herpes: A pregnant parent who has genital herpes, can transmit the virus to their newborn during delivery. If you are pregnant and have a history of genital herpes, your doctor will start you on medication to decrease the risk of this happening. 

How to protect yourself from transmission

Preventing genital herpes, along with many other STIs, can include a multitude of methods, including:

  • Correct and consistent condom use for penetrative sex. Using dental dams and/or condoms for oral sex.
  • Practicing ideal hygiene before and after sexual activity, including:
  1. Washing your body and genitals before and after sexual activity
  2. Using alcohol-based mouthwash after oral sex
  3. Avoiding flossing your teeth within thirty minutes of giving oral sex
  • Speaking to your sexual partners about their STI and testing history.  
  • Avoid any sexual contact with partners that have genital herpes when they are experiencing an outbreak, or they begin having symptoms that signal an outbreak (such as burning or tingling in the infected area). The risk of transmission of genital herpes is highest during an outbreak. 
  • Encourage sexual partners who have genital herpes to discuss taking antiviral medications with their healthcare provider, which can reduce their number of outbreaks and lower their risk of transmitting HSV.
  • Get tested (and treated) for STI's on a regular basis.

Is there currently a cure for genital herpes?

Unfortunately, genital herpes does not currently have a cure, but it is a manageable condition that can be treated. There are antiviral medications that can help manage outbreak symptoms by reducing the severity, frequency, and duration of recurrent outbreaks.

Are there any current studies being performed to improve prevention methods, available medicine/treatments, or find a cure?

Research into vaccines for genital herpes has been ongoing for several years. Gene-editing experimentation is also underway to help find a permanent cure for genital herpes. 


Sources:

  • https://www.fredhutch.org/en/news/center-news/2020/08/herpes-simplex-gene-therapy.html
  • https://www.newsweek.com/meet-paranthropus-boisei-ancient-hominin-gave-humans-genital-herpes-674850
  • https://www.healthlinkbc.ca/medical-tests/hw264763
Reviewed by:
Dr. Caley Shukalek

Caley is passionate about evidence-based, patient-centred care, including telemedicine that can provide high quality care from wherever a patient may choose.

He helped create Alberta's PrEP guidelines and works as a specialist in General Internal Medicine with additional training in sexual health, including HIV and sexually transmitted infections.

He holds an Masters of Public Health from Johns Hopkins University, an MD from the University of Calgary and an MSc from the University of Alberta.