Genital herpes is caused by transmission of the herpes simplex virus (HSV). This is the same type of virus which causes cold sores. However, in most genital cases, the actual strain of HSV is different from the one which most commonly causes cold sores.
The first (primary) attack of genital herpes is usually the worst. The vulva and the vagina or the head (glans) of the penis develop a crop of itchy and painful sores. The patient is unwell with a fever and enlarged lymph glands in the groin. Urination may be difficult.
The infection heals over the next seven days with crusting of the spots. In 30% of people there is recurrence of the attack (secondary herpes), as the virus is never fully cleared from the body. The attack is usually limited to a smaller area of the genital organs and is often progressively less painful in each recurrence. Only 2-5% of people who have had genital herpes have more than one recurrent attack. Recurrence is more common in the second half of the menstrual cycle, during periods of stress and in hot weather.
The person is only infectious during an attack and its recovery phase. Recurrent herpes is a very serious condition during pregnancy as it can severely infect a baby during delivery. If a woman goes into labour with active herpes, then caesarian section is advised. In severe cases, anti-viral drugs (including acyclovir) may be prescribed on a long term basis to prevent attacks. However, in most cases these are not prescribed, and the recurrence subsides naturally within a few days.
In Chinese medicine genital herpes corresponds to Wind-Damp-Heat. It primarily affects the Liver Channel.
