From the Guidelines
No, genital herpes does not always cause pain. Many people with genital herpes experience no symptoms at all or have such mild symptoms that they go unnoticed. When symptoms do occur, they can range from mild discomfort to painful blisters or sores in the genital area. The first outbreak is typically the most severe and may include flu-like symptoms such as fever, body aches, and swollen lymph nodes along with genital pain, itching, burning, and sores. Subsequent outbreaks are usually less severe and shorter in duration. The herpes simplex virus (HSV) that causes genital herpes remains dormant in nerve cells between outbreaks, and various triggers like stress, illness, menstruation, or sun exposure can reactivate the virus. Even without visible symptoms, a person can still transmit the virus to others through a process called asymptomatic shedding. If someone suspects they have genital herpes, they should seek medical attention for proper diagnosis and treatment options, which may include antiviral medications like acyclovir, valacyclovir, or famciclovir to reduce the severity and frequency of outbreaks, as recommended by the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines 1.
Some key points to consider:
- Genital herpes is a chronic sexually transmitted infection (STI) characterized by recurrent, self-limited genital ulcers, caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) 1.
- Accurate diagnosis of genital herpes can be realized using type-specific molecular or virologic tests when genital ulcers are present, and type-specific serologic test to detect antibody when lesions are not present 1.
- Genital herpes can be managed either by episodic antiviral therapy, in which patients take short courses of antiviral therapy at the time of a genital herpes recurrence, or suppressive antiviral therapy, in which patients take medications on a daily basis to prevent recurrences and shedding 1.
- The virus may be present in the genital tract without symptoms, leading to transmission to sex partners or neonates, when present in the genital tract during delivery 1.
It is essential to note that the management of genital herpes should prioritize reducing the severity and frequency of outbreaks, as well as preventing transmission to others. Antiviral medications like acyclovir, valacyclovir, or famciclovir can be effective in achieving these goals, as supported by the most recent guidelines 1.
From the Research
Genital Herpes and Pain
- Genital herpes is a sexually transmitted infection caused by herpes simplex virus (HSV) type 1 or 2, affecting at least 500 million people worldwide 2.
- It is a lifelong condition involving initial infection and periodic reactivation with variable viral shedding.
- A clinically apparent herpes outbreak is characterized by painful vesicles on the genitals, rectum, or perineum and may be accompanied by a flulike syndrome of fever, malaise, and lymphadenopathy 2.
Asymptomatic Genital Herpes
- Most new cases of genital HSV are not diagnosed due to HSV infections having short-lived signs and symptoms, or in many instances are asymptomatic 3.
- Many people infected with HSV are unaware that they have it, and the risk of transmission to a partner is highest during outbreak periods, when there are visible lesions, although genital HSV can also be transmitted during asymptomatic periods 3.
Treatment and Prevention
- Antiviral agents are effective in controlling clinical episodes, but do not eradicate infection, which remains latent for the life of a patient 3.
- Suppressive antiviral therapy with acyclovir, valacyclovir or famciclovir in patients experiencing at least four recurrences of genital herpes per year decreases the number of patients with at least one recurrence as compared with placebo 4.
- Practices that prevent or reduce transmission include the use of suppressive antiviral therapy in serodiscordant partners, avoiding sexual contact during outbreaks, and use of condoms 2.