All men have experience with viruses. Influenza and the common cold are all too familiar. Genital herpes is also common but, unlike colds and flu, mostly travels incognito. This chronic viral infection, marked by recurrent genital skin lesions, spreads by sexual contact. In 2010, the Centers for Disease Control and Prevention tested more than 7,000 Americans ages 14 to 49, and found that 1 of every 6 was infected with the HSV-2 virus. However, only 20 percent of those infected had been diagnosed by a physician. The other 80 percent were unaware of their herpes.
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The herpes virus HSV-2 causes the majority of genital herpes infections. HSV-1, which causes cold sores of the lips and mouth, is responsible for the rest. Men can acquire genital herpes from contact with healthy-looking skin, mucosa or secretions, or active herpes lesions. Condoms are only partially protective as they may not cover the infected area. Symptoms typically arise 2 to 12 days after contact, but often are not apparent. Flu-like symptoms, such as fever, headache, body aches and swollen glands, are not uncommon with initial infection. Men with mild symptoms, or who attribute them to another viral illness, may not suspect they have contracted herpes.
Classically, men notice one lesion or a cluster of small sores on their penis, scrotum, thighs, mouth, buttocks or anal area. Starting as bumps that become blisters filled with fluid, the lesions eventually rupture into painful ulcers which become crusty and scab over. After a week or so, they heal. Lesions inside the urethra may cause burning with urination. Sometimes the initial outbreak has more than one crop of lesions. Tingling, itching and aching, along with red and cracked skin, may accompany the skin lesions. The whole cycle can take 2 to 4 weeks. Some men may not develop skin lesions.
Reactivations and Recurrences
Typically, a man with a herpes infection has recurrent outbreaks of skin lesions. These outbreaks may follow exposure to UV light, stress or fatigue. Tingling, aching or discomfort in the affected area often precedes the lesions by 12 to 24 hours, warning that the virus is reactivating. Recurrent outbreaks are usually less severe than the one following the initial infection. HSV-2 recurrence might occur 3 or 4 times a year, typically decreasing in frequency after the first year. Male infertility and an increased risk of acquiring the HIV virus have been associated with genital herpes infections.
Diagnosis and Treatment
Consultation with a health-care provider should be sought when genital herpes is suspected. Several sexually transmitted diseases, including syphilis, can cause genital lesions. Sometimes only a laboratory test can differentiate between these infections. Genital herpes is typically diagnosed by a physical examination, a blood test and a culture of visible lesions. Prescription antiviral medication is available. Antivirals can decrease the severity of symptoms, shorten the duration of an outbreak, decrease the likelihood of spreading it to partners and suppress recurrences. Consultation also provides the opportunity to discuss strategies to minimize the impact of this virus on a man's life.
REFERENCES & RESOURCES
- Centers for Disease Control and Prevention: Seroprevalence of Herpes Simplex Virus Type 2 Among Persons Aged 14--49 Years --- United States, 2005--2008
- Archives of Internal Medicine: A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition
- The Journal of Biomedical Research: Asymptomatic seminal infection of herpes simplex virus: impact on male infertility
- Human Reproduction: Sexual Violence, HSV-2 and HIV Are Important Predictors for Infertility in Rwanda
- AIDS: Foreskin Inflammation is Associated with HIV and Herpes Simplex Virus Type-2 Infections in Rakai, Uganda
- PloS One: Etiology of Genital Ulcer Disease in a Sexually Transmitted Infection Reference Center in Manaus, Brazilian Amazon
- Sexually Transmitted Diseases: Clinician and Patient Recognition of Anogenital Herpes Disease in HIV Positive Men Who Have Sex with Men
- Dermatology Online Journal: Perianal Dermatoses Among Men Who Have Sex with Men, a Clinical Profile of 32 Indian Patients
- American Academy of Dermatology: Herpes Simplex, Signs and Symptoms
- American Sexual Health Association: Herpes Resource Center
- Centers for Disease Control and Prevention: Genital Herpes – CDC Fact Sheet