“I’ve got this yeast infection that just won’t go away. I had itching and burning, so I used an over the counter cream. I think I had an allergic reaction to it though, because now I’m all swollen and irritated down there.” I get some variation of that complaint almost weekly from a patient. Each time I hear it, I get a sense of dread, because I know 9 times out of 10 it’s not a yeast infection we’re dealing with but genital herpes.
In the OB/GYN world, we call herpes the “glitter” of STDs because it seems to spread everywhere. It is extremely common. Currently 20% of the US population tests positive for genital herpes.
Genital herpes, formally known as herpes type 2 (HSV 2), isn’t the only brand of herpes – but it is the one with the more significant symptoms. Herpes type 1 (HSV 1), though traditionally associated with fever blisters on or around the mouth, can be transmitted to the genitals (thanks to oral sex), but the symptoms are usually milder than HSV 2.
Genital herpes is sexually transmitted, through intercourse (vaginal/anal or oral) or any genital to genital contact. Transmission can occur even when there are no active lesions. While condom use can reduce transmission, it doesn’t fully prevent it because the virus lives in the skin around the genitals. Initial symptoms usually appear within 3-7 days and often include fever, body aches, headaches and tingling sensations in the labia. Then clusters of genital blisters pop up and glands in the groin begin to swell. The blisters usually open and become raw, painful sores that eventually crust over. While it’s most common for women to have lesions on their labia, they can also get them on their buttocks or inner thigh as well, essentially all the skin that short shorts would cover. The initial outbreak can vary from mild irritation to incapacitating pain. Sometimes the symptoms are milder, like burning with urinating or mild vaginal irritation, and can be confused with a yeast infection or UTI. The initial outbreak can last up to 4 weeks if left untreated. Outbreaks are most frequent the first year of transmission and then decrease in frequency.
The most common question I get from patients diagnosed with herpes is, “How long have I had it?” (which of course really means, “Who did I get this from?”). Unfortunately, this is not always a question I can answer. A patient’s blood work can tell me if transmission happened within the past 6 weeks – but that’s as far back as I can see. So there are some patients who will never know who gave them herpes. And, in truth, the person who gave it to them might not even know they have it – up to 70% of those with herpes will never have any symptoms, and so may not get diagnosed (and may not know to protect their partners). (Like I said, “glitter.”)
While there is currently no cure for herpes, it’s not a death sentence either. It doesn’t shorten your life span or affect your ability to have children (although if you do have an outbreak at the time of delivery, a C-section is recommended to prevent transmission to the baby). And as I remind my patients, despite the perceived stigma, HSV is very common – if you’ve been diagnosed, you’re not alone.
And having genital herpes doesn’t mean you can’t have sex – you just need to be responsible and careful. Obviously it is important to tell future partners before you are sexually intimate, but you can also let them know that if you are taking daily suppressive antiviral medication and your partner uses a condom then your risk of transmission is very low, approximately 1/1000. I recommend that you encourage your partner to be screened by blood work to see if they might already have the virus, as a significant number of men have HSV with no symptoms.
If you have a persistent vaginal burning or ulcers, it could be HSV, so see your provider to get it checked out. If it is herpes please realize that most people with HSV lead normal lives, and while the outbreaks can be annoying, they are manageable with medications. Herpes is no fun, but it’s very common, and it’s not going to kill you – or your sex life.