Genital Herpes

Topic Overview

What is genital herpes?

Genital herpes is one of the most common sexually transmitted diseases (STDs). The disease can be bothersome. But if you are a healthy adult, you do not need to worry that it will cause serious problems.

Most people never have symptoms, or the symptoms are so mild that people do not know that they are infected. But in some people, the disease causes occasional outbreaks of itchy and painful sores in the genital area.

After the first outbreak, the herpes virus stays in the nerve cells below the skin and becomes inactive. It usually becomes active again from time to time, traveling back up to the skin and causing more sores. Things like stress, illness, a new sex partner, or menstruation may trigger a new outbreak. As time goes on, the outbreaks happen less often, heal faster, and don't hurt as much.

What causes genital herpes?

Genital herpes is caused by a virus-either the herpes simplex virus type 1 or the herpes simplex virus type 2. Either virus can cause sores on the lips (cold sores) and sores on the genitals. Type 1 more often causes cold sores, while type 2 more often causes genital sores.

What are the symptoms?

Symptoms can vary greatly from person to person. Most people never have any symptoms. Sometimes the symptoms are so mild that people may not notice them or recognize them as a sign of herpes. For people who do notice their first infection, it generally appears about 2 to 14 days after they were exposed to genital herpes.

Some people have outbreaks of itchy and painful blisters on the penis or around the opening of the vagina. The blisters rupture and turn into oozing shallow sores that take up to 3 weeks to heal. Sometimes people, especially women, also have flu-like symptoms, such as fever, headache, and muscle aches. They may also notice an abnormal discharge and pain when they urinate.

Genital herpes infections can be severe in people who have impaired immune systems, such as people with HIV.

How is genital herpes diagnosed?

Your doctor may diagnose genital herpes by examining you. He or she may ask you questions about your symptoms and your risk factors, which are things that make you more likely to get a disease.

If this is your first outbreak, your doctor may take a sample of tissue from the sore for testing. Testing can help the doctor be sure that you have herpes. You may also have a blood test.

How is it treated?

Although there is no cure, medicine can relieve pain and itching and help sores heal faster. If you have a lot of outbreaks, you may take medicine every day to keep the number of outbreaks down.

After the first outbreak, some people have just a few more outbreaks over their lifetime, while others may have 4 to 6 outbreaks a year. Usually the number of outbreaks decreases after a few years.

Treatment works best if it is started as soon as possible after the start of an outbreak. This is especially true for outbreaks that come back again and again.

Finding out that you have herpes may cause you to feel bad about yourself or about sex. Counseling or a support group may help you feel better.

Can genital herpes be prevented?

The only sure way to keep from getting genital herpes-or any other sexually transmitted disease (STD)-is to not have sex. If you do have sex, practice safe sex.

• Before you start a sexual relationship, talk with your partner about STDs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
• If you have symptoms of an STD, don't have sex.
• Don't have sex with anyone who has symptoms or who may have been exposed to an STD.
• Don't have more than one sexual relationship at a time. Having several sex partners increases your risk for disease.
• Use condoms. Condom use lowers the risk of spreading or becoming infected with an STD.
• Don't receive oral sex from partners who have cold sores.

Taking medicine for herpes may lower the number of outbreaks you have and lower the chances that you will infect your partner.

If you are pregnant, you should take extra care to avoid getting infected. You could pass the infection to your baby during delivery, which can cause serious problems for your newborn. If you have an outbreak near your due date, you probably will need to have your baby by cesarean section. If your genital herpes outbreaks return again and again, your doctor may talk to you about medicines that can help prevent an outbreak during pregnancy.

Vaccines that can prevent a genital herpes infection are not available yet, but several are being studied.

Frequently Asked Questions

Cause

Genital herpes can be caused by either the herpes simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2). HSV-1 or HSV-2 can cause sores on the lips (cold sores ) and sores on the genitals. HSV-1 more often causes cold sores. HSV-2 more often causes genital sores. HSV-1 causes up to 50% of primary genital herpes infections. Genital herpes caused by HSV-1 has a lower rate of recurrence than that caused by HSV-2.¹

How the herpes virus is spread

The same virus that causes genital herpes also can cause cold sores (herpes labialis), so HSV can be spread from a genital sore to the lips or from a cold sore to the genital area. HSV can be spread to or from the genitals, anus, or mouth during sexual activities or through any direct contact with herpes sores. You become infected when the virus enters your body through a break in the skin or through moist areas (mucous membranes) such as the mouth, anus, and vagina. Even very small breaks in the skin allow the virus to infect the body.

Newborns can be infected with HSV at birth. This usually happens when a woman has her primary outbreak (the first time she is infected with HSV) close to the time of delivery and the baby is delivered through the vagina. Usually in these cases the woman either does not have symptoms or is unaware of symptoms. The chance of passing the virus to the baby is greatly reduced (less than 1% of the time) during recurrent outbreaks, which occur after a woman has been infected previously.¹ Babies infected with the virus at birth are at risk for serious health problems.

Contagious period

You are most likely to spread HSV when you have a sore or blister during either a primary or recurrent outbreak. But many people who have genital herpes have time periods (a week before and a week after an outbreak) when they can spread the virus even though they do not have blisters or sores present. Some people can spread the infection when they do not recognize that they have a genital herpes sore or when they have symptoms (such as painful urination) that are not typical of genital herpes.

Symptoms

Genital herpes symptoms can vary greatly from person to person. Most people never have any symptoms or have ones that are so mild they may not recognize them. But some people have painful and bothersome symptoms. Sometimes the symptoms are confused with other common problems, like yeast infections or vaginosis.

First-time (primary) outbreak

The primary outbreak of genital herpes is the first infection with HSV. It tends to last longer and be more severe than subsequent (recurrent) outbreaks. Symptoms of a primary outbreak may include:

• Flu-like symptoms, such as fever, headache, and muscle aches. These symptoms usually get better within a week.
• Tingling, burning, itching, and redness at the site where an outbreak is about to occur (prodrome).
• Painful, itchy blisters on the penis, on the vulva, or inside the vagina. Blisters may also appear on the anus, buttocks, thighs, or scrotum, either alone or in clusters. They may be barely noticeable or as large as a coin.
• Blisters that break and become shallow, painful, oozing sores.
• Swollen and tender lymph nodes in the groin.
• Painful urination.
• Abnormal vaginal or urethral discharge.

Sometimes a person will first experience symptoms months or even years after being infected. This can make it very difficult to identify the sex partner who was the source of the infection.

Recurrent outbreaks

Recurrent outbreaks of HSV cause painful blisters that rupture, become sores, and heal after 6 to 12 days. Symptoms of recurrent outbreaks are usually limited to genital blisters, sores, and swollen glands. The blisters are most painful during the first 24 hours after they appear. Most people do not have flu-like symptoms with recurrent outbreaks. Recurrent outbreaks are usually less severe and do not last as long as primary outbreaks.

Symptoms of genital herpes infections in both primary and recurrent outbreaks tend to be more severe in women than in men.

What Happens

You can become infected with genital herpes when the herpes simplex virus (HSV) enters the body through sexual or other direct contact with herpes sores. HSV infections cannot be cured. After you are infected with HSV, the virus remains in your body for the rest of your life. Many people do not have symptoms and thus are unaware that they have the virus.

First-time (primary) outbreak

The incubation period-the time from exposure to genital herpes until the primary outbreak of infection-is generally 2 to 14 days. But most people may not notice their first infection. The entire body may be affected, causing you to feel as though you have the flu. Blisters appear around the genitals or anus or in the area where the virus entered the body. The blisters break within a few days and become painful, oozing sores. The sores usually heal within 3 weeks (without treatment) and do not leave scars. Sores that occur in women usually take longer to heal than sores that occur in men.

Recurrent outbreak

After the primary outbreak, the herpes simplex virus remains in the nerve cells below the skin in the area where the sores first appeared. The virus stays in the nerve cells but becomes dormant, causing no symptoms. In most people, the virus becomes active from time to time, traveling from the nerve cells to the skin and causing repeated blisters and sores (recurrent outbreaks).

Sores from recurrent outbreaks usually heal faster and are less painful than those from the primary outbreak. People report that certain factors such as stress, illness, new sex partners, or menstruation may trigger recurrent outbreaks.

About half of the people who have recurrent outbreaks of genital herpes feel an outbreak coming a few hours to a couple of days before it happens. They may feel tingling, burning, itching, numbness, tenderness, or pain where the blisters are going to appear. This is called the prodrome.

People who have symptoms average five outbreaks a year during the first few years. Most have fewer outbreaks after that. The pattern of recurrent outbreaks-how often genital herpes infections return and how long outbreaks last-varies greatly. Some people have many outbreaks each year while others have only a few or none at all.

Genital herpes infections caused by HSV-1 recur less frequently than those caused by HSV-2 and often cause less severe symptoms.

Other problems from the herpes simplex virus

Genital herpes can affect many body systems and cause other health problems, especially the first time a person becomes infected (primary outbreak).

People who have an impaired immune system are more likely to have longer and/or more severe outbreaks of genital herpes than people whose immune systems are healthy.

Genital herpes in newborns

Newborns may be infected with HSV at birth. This usually happens when a woman has her primary outbreak close to the time of delivery and the baby is delivered through the vagina. Usually in these cases the woman either does not have symptoms or is unaware of symptoms. The risk of passing the virus to the baby is greatly reduced during recurrent outbreaks, occurring less than 1% of the time.¹

A pregnant woman who has visible signs of an outbreak near her due date may be tested for HSV. The risk of passing HSV to the baby during delivery is much higher during a primary outbreak than a recurrent outbreak.

If a genital herpes blister or sore is present at the time of labor and delivery, whether it is part of a primary or recurrent outbreak, a cesarean section is usually done. Cesarean section may be recommended if a woman has tingling or pain (prodromal symptoms) suggesting an impending outbreak.

Because their immune systems are not fully developed, newborns with herpes infection can have serious health problems affecting many body systems. It may take up to 3 weeks after a newborn is infected before he or she becomes ill.

What Increases Your Risk

Factors that increase your risk of getting genital herpes include:

• Having multiple sex partners.
• Having a high-risk partner or partners (partner has multiple sex partners or HSV-infected sex partners).
• Having unprotected sexual contact (not using condoms).
• Starting sexual activity before age 18.
• Having an impaired immune system.
• Being a woman. Women are more likely than men to become infected when exposed to HSV and tend to have more severe and longer-lasting symptoms. Women also are at a greater risk of having complications from a genital herpes infection.

Infection with HSV, especially if you have open sores, also increases your risk for becoming infected with the human immunodeficiency virus (HIV) if you are exposed to HIV.

Factors that may increase your risk for recurrent genital herpes outbreaks include:

• Emotional stress.
• Fatigue.
• Other infections, such as a cold or the flu.
• Physical injury, such as irritation, of the genital area.
• Any condition that impairs your immune system.

Any child with genital herpes needs to be evaluated by a doctor to determine the cause and to assess for possible sexual abuse. For more information, see the topic Child Abuse and Neglect.

When To Call a Doctor

Call your doctor if you have not been diagnosed with genital herpes and you have any of the following:

• Painful blisters or sores in the genital or pelvic area
• Burning or pain while urinating, or you are unable to urinate
• Abnormal vaginal or urethral discharge
• Reason to suspect you have been exposed to genital herpes infection. (This is especially important if you are pregnant.)

If you have been diagnosed with genital herpes and are having frequent recurrent outbreaks, discuss your symptoms with your doctor.

If you are pregnant and have been diagnosed with genital herpes or think you have genital herpes, tell your doctor.

Watchful Waiting

Any blisters, sores, or other symptoms that suggest genital herpes infection or another sexually transmitted disease (STD) should be evaluated by a doctor. To prevent transmitting an infection to another person, avoid sexual contact until you have been examined by your doctor.

If you have only occasional recurrent outbreaks of genital herpes and are comfortable with home treatment, watchful waiting may be appropriate for you.

Who To See

Health professionals who can diagnose genital herpes include:

• Nurse practitioners.
• Physician assistants.
• Family medicine physicians.
• Internists.
• Gynecologists.

Treatment may require a referral to a specialist, such as a:

• Gynecologist.
• Urologist.
• Dermatologist.
• Infectious disease specialist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Genital herpes is usually diagnosed based on your medical history and a physical exam. Your doctor may ask you the following questions:

• Do you think you were exposed to genital herpes or another sexually transmitted disease (STD)? How do you know? Did your partner tell you?
• What are your symptoms?
  • Do you have sores in the genital area or anywhere else on your body?
  • Do they usually come and go?
  • Do you have any urinary symptoms, including frequent urination, burning or stinging with urination, or urinating in small amounts?
  • If you have discharge from the vagina or penis, it is important to note any smell or color.
• What method of birth control do you use? Did you use condoms to protect against STDs?
• Which high-risk sexual behaviors do you or your partner engage in?
• Have you had an STD in the past? How was it treated?

After the medical history is taken:

• A woman will have a gynecological exam. A Pap test is not specific for genital herpes but may be included, depending on the woman's medical history.
• A man will have a genital exam to check for HSV infection.

Your doctor may be able to diagnose genital herpes from your medical history and physical exam, especially if the herpes sores are typical in appearance. But if this is your first outbreak of suspected genital herpes, further testing may be done to confirm the diagnosis.

Herpes tests cannot always show if you have a primary genital herpes outbreak or you have been infected in the past. Sometimes a test result can be negative even though the person has herpes.

Treatment Overview

The goal of treatment for genital herpes is to provide relief from the discomfort of herpes sores and to reduce the time it takes for an outbreak to heal.

Treatment works best if it is started as soon as possible after an outbreak begins. This is especially true for outbreaks that come back again and again.

Initial treatment

Most people find some relief and recover more quickly from the first (primary) outbreak of genital herpes by taking antiviral medicines.

• Use medicines to relieve symptoms and speed healing of blisters and sores.
  • Antiviral medicines, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex) are recommended for treating primary genital herpes outbreaks.
  • Nonprescription medicines, such as ibuprofen (Advil) or acetaminophen (Tylenol), may reduce the pain and fever from genital herpes.
• Use home treatment, such as taking warm sitz baths and wearing cotton underwear, to promote healing of herpes sores. For more information, see the Home Treatment section of this topic.
• Take steps to prevent the spread of genital herpes. These include avoiding any sexual contact if you or your partner have symptoms or are being treated for genital herpes. For more information, see the Prevention section of this topic.

Antiviral medicine may reduce the time it takes a first outbreak to heal. The medicine also decreases the number of days you can spread the virus (are contagious).

Taking antiviral medicine for the primary genital herpes outbreak does not prevent genital herpes outbreaks from recurring.

Ongoing treatment

The decision to take antiviral medicines for recurrent outbreaks of genital herpes depends on how long the outbreaks last, how severe they are, and how often they return. People who do not have frequent or severe outbreaks may not want to take medicine on a regular basis.

Antiviral medicines reduce the time it takes for genital herpes sores to heal and helps prevent some outbreaks. Antiviral medicines have the added benefit of reducing the possibility that people can transmit HSV to their sex partner(s).

People can take antiviral medicine for recurrent outbreaks of genital herpes either:

• Every day. Some people take antiviral medicine every day to help reduce the risk of recurrent outbreaks and reduce how long a recurrent outbreak lasts. Antiviral medicine may reduce the number of outbreaks by about one or two episodes a year.
• As needed. Some people take antiviral medicine when they first notice the prodromal symptoms (tingling and pain) of a recurrent outbreak. To be effective, a medicine taken only for 2 or 3 days must be used at higher doses than when the medicine is taken every day.

A study has shown that an HSV-infected person in a heterosexual, single-partner (monogamous) relationship who takes valacyclovir daily to prevent recurrent outbreaks reduces by about half the risk of infecting his or her partner.² Other antiviral medicines may also reduce transmission but further study is needed.

Home treatment, such as taking warm sitz baths and wearing cotton underwear, can promote healing of herpes sores. For more information, see the Home Treatment section of this topic.

You can reduce the risk of transmitting HSV to your sex partner(s) by taking steps to prevent the spread of genital herpes. These include avoiding any sexual contact if you or your partner have symptoms or are being treated for genital herpes. Using condoms during outbreaks also reduces the risk of giving HSV to your partner.³ For more information, see the Prevention section of this topic.

Treatment during pregnancy

The Centers for Disease Control and Prevention (CDC) has published guidelines about the use of antiviral medicines for genital herpes during pregnancy.¹

• Oral acyclovir (Zovirax) may be given to pregnant women for a primary HSV infection or for severe recurrent outbreaks.
• Oral acyclovir may be given to pregnant women at any time during the pregnancy, including the first trimester.
• Acyclovir may be given intravenously (IV) to pregnant women with severe HSV infection.
• Acyclovir may decrease the frequency of recurrent outbreaks in pregnant women close to delivery, thereby reducing the possibility of needing a cesarean section at the time of delivery.

If a genital herpes blister or sore is present at the time of labor and delivery, a cesarean section is usually done. A cesarean section may be recommended if a woman has tingling or pain (prodromal symptoms), suggesting an impending outbreak. Acyclovir (Zovirax) used in the last 4 weeks of pregnancy may reduce the need for delivery by cesarean section by reducing the risk of a recurrent outbreak at the time of delivery.

Prevention

You can take measures to reduce your risk of becoming infected with genital herpes (HSV) infection or another sexually transmitted disease (STD). You can also reduce the risk of transmitting HSV to your sex partner(s).

Practice safe sex

Preventing an STD is easier than treating an infection after it occurs.

• Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is quite possible to be infected with an STD without knowing it. Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood.
• Be responsible.
  • Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
  • Avoid sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
• Don't have more than one sexual relationship at a time. Your risk for an STD increases if you have several sex partners.

For more information, see the topic Safe Sex.

Vaccines that can prevent a genital herpes infection are not currently available. But research has shown that an HSV-infected person in a heterosexual, single-partner (monogamous) relationship who takes the antiviral medicine valacyclovir daily to prevent recurrent outbreaks also reduces the risk of infecting his or her partner.² Other antiviral medicines may also reduce transmission, but further study is needed.

Condom use

Condom use reduces the risk of spreading or becoming infected with an STD, including genital herpes. Condoms must be in place before beginning any sexual contact. Use condoms with a new partner until you are certain he or she does not have an STD. You can use either male or female condoms.

Even if you are using another birth control method to prevent pregnancy, you may wish to use condoms to reduce your risk of getting an STD. Female condoms are available for women whose male partners do not have or will not use a condom.

Doctors recommend that people abstain from sex while they feel tingling or pain in the genital area, which may indicate an HSV outbreak is coming (prodrome), or when a genital herpes blister or sore is present. At other times, condoms help reduce transmission of HSV even when blisters or sores are not present.

Genital herpes and pregnancy

A woman who gets genital herpes while she is pregnant is at risk of passing the infection to her baby during delivery. A newborn can become seriously ill if infected with the herpes simplex virus. For this reason it is very important to prevent genital herpes infection during pregnancy.

• Tell your doctor if you have been exposed to genital herpes or have had an outbreak in the past.
• Let your doctor know if you are currently having an outbreak of genital herpes, especially if it is during the last part of your pregnancy.
• Avoid unsafe sex. Genital herpes infection is often transmitted by people who do not know they are infected and do not have symptoms. Use condoms.
• Avoid receiving oral sex from partners who have cold sores. Herpes in newborns can be caused by HSV-1, the virus that most commonly causes cold sores. Most experts advise pregnant women not to receive oral sex in the last three months of their pregnancy. It increases their risk of genital infection with HSV-1.
• Antiviral medicine can be used safely in pregnancy to reduce the number of outbreaks or shorten the length of an outbreak.

If you are having a genital herpes outbreak, wash your hands after using the bathroom or having any contact with blisters or sores. This is especially important for people who are caring for babies.

Home Treatment

Home treatment for genital herpes focuses on relieving symptoms, reducing the risk of recurrent outbreaks, and helping you cope with a lifelong condition.

To reduce discomfort from herpes sores:

• Take warm sitz baths or wash the area with warm water 3 or 4 times a day.
• In between sitz baths, keep the sores clean and dry.
• Using a hair dryer to dry off the sores may be more comfortable than using a towel.
• Wear cotton underpants, which absorb moisture better than those made from synthetic material.

Nonprescription medicines may reduce the pain and fever from genital herpes.

To lower the risk of recurrent outbreaks, reduce or avoid factors that trigger outbreaks, such as overexposure to sun, fatigue, irritation of the genital area, and stress.

Finding out that you have genital herpes may cause you to have negative thoughts or feelings about yourself or about sex, such as:

• Feeling ashamed or embarrassed.
• Being afraid of the consequences of the infection.
• Being angry at the person who infected you.
• Feeling frustrated with treatment or recurrent outbreaks.
• Feeling scared to have sex.

A counselor or support groups for people with herpes may be helpful. For more information, see the Other Places to Get Help section of this topic.

Genital herpes can be bothersome. But if you are a healthy adult, you do not need to worry that it will cause serious problems.

Medications

Antiviral medicines are the recommended treatment for herpes simplex virus (HSV) infection.

Medication Choices

Acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex)

The topical form of acyclovir (Zovirax ointment) offers little benefit in the treatment of genital herpes and is not recommended.

What To Think About

People taking antiviral medicine every day (suppressive therapy) may want to talk to their doctors about not taking the medicine for a short period each year. This can help determine whether genital herpes outbreaks recur as frequently. They can then decide whether they need to continue taking medicine. People who have six or more outbreaks a year or who have severe outbreaks may benefit from taking antiviral medicine every day.

Antiviral medicines for genital herpes work best when they are taken as soon as symptoms are noticed. For that reason, people with herpes should keep a supply of the medicine on hand.

Acyclovir (Zovirax) is most commonly used for pregnant women. Valacyclovir (Valtrex) also may be used during pregnancy.^{4, 5}

People with impaired immune systems may be more likely to:

• Need daily antiviral medicine to prevent recurrent outbreaks.
• Develop a resistance to some antiviral medicines. For these people, other antivirals are available, but they must be given through a vein (intravenously, or IV) and can have dangerous side effects.

Surgery

There is no need for surgical treatment for genital herpes. But if you are pregnant and genital herpes is diagnosed or suspected at the time of labor and delivery, a cesarean section (surgical) delivery may be recommended to protect the baby from getting a herpes simplex infection, which can cause serious health problems. A mother can pass the herpes simplex virus (HSV) to her baby if she has a sore or blister present during a vaginal delivery.

The biggest risk occurs during a first-time (primary) outbreak of genital herpes. Usually in these cases the woman either does not have symptoms or is unaware of symptoms. Experts disagree about the use of cesarean section delivery in women with recurrent outbreaks of genital herpes. If a pregnant woman has recurrent outbreaks, the risk of passing the virus to her baby is less than 1% because the baby has some immune protection from the mother.¹

Cesarean section may be recommended if a woman has symptoms such as tingling or pain (prodromal symptoms) that signal an impending outbreak. For these women, acyclovir (Zovirax) used in the last 4 weeks of pregnancy may reduce the need for delivery by cesarean section by reducing the risk of a recurrent outbreak at the time of delivery.

A cesarean section is usually not done if a woman with recurrent genital herpes has blisters or sores only on her thighs, buttocks, or another area that is not close to the vagina.

Other Treatment

Some people find complementary medicine helpful in reducing recurrent outbreaks of genital herpes. Results from one small study show that the amino acid lysine may reduce the number of outbreaks and promote healing for some people. A dose of 1,000 mg 4 times a day (up to 4,000 mg a day) at the beginning of herpes symptoms is recommended and has been shown to be safe and free of side effects.⁶ People with liver or kidney disease should not take lysine.

Other Places To Get Help

Organizations

Related Information

• Cesarean Section
• Chlamydia
• Cold Sores
• Exposure to Sexually Transmitted Diseases
• Human Immunodeficiency Virus (HIV) Infection
• Safe Sex

References

Citations

1. U.S. Department of Health and Human Services (2006). Genital HSV infections. Sexually Transmitted Diseases Treatment Guidelines 2006 (CDC Publication Vol. 55, No. RR-11), pp. 16-20. Atlanta: U.S. Department of Health and Human Services. Available online: http://www.cdc.gov/std/treatment/2006/rr5511.pdf.

2. Corey L, et al. (2004). Once-daily valacyclovir to reduce the risk of transmissioin of genital herpes. New England Journal of Medicine, 350(1): 11-20.

3. Wald A, et al. (2005). The relationship between condom use and herpes simplex virus acquisition. Annals of Internal Medicine, 143(10): 707-713.

4. Andrews WW, et al. (2006). Valacyclovir therapy to reduce recurrent genital herpes in pregnant women. American Journal of Obstetrics and Gynecology, 194(5): 774-781.

5. Sheffield JS, et al. (2006). Valacyclovir prophylaxis to prevent recurrent herpes at delivery. Obstetrics and Gynecology, 108(1): 141-147.

6. Lysine (2004). Review of Natural Products. St. Louis: Wolters Kluwer Health.

Other Works Consulted

• American College of Obstetricians and Gynecologists (2007). Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. Obstetrics and Gynecology, 109(6): 1489-1498.

• Corey L (2005). Herpes simplex virus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th edition, vol. 2, pp. 1762-1780. Philadelphia: Elsevier.

• Wald A, et al. (2003). Genital herpes. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 3rd ed., pp. 241-259. New York: Mosby.

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