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Genital herpes

Genital herpes is caused by herpes simplex virus (type I or type II). Both types can infect the mouth (producing cold sores) or the genital area (genital herpes).

Genital herpes is a sexually transmitted disease which affects both men and women and is caused by herpes simplex virus type 2. It can be transmitted through intimate contact with the mucous-covered linings of the mouth or the vagina or the genital skin. The virus enters the linings or skin through microscopic tears or through cracks in the skin and mucous membranes. Once inside, the virus travels to the nerve roots near the spinal cord and settles there permanently.

Sometimes genital herpes called “herpes” – it is a viral infection by the herpes simplex virus (HSV). When an infected person has a herpes outbreak, the virus travels down the nerve fibers to the site of the original infection. When it reaches the skin, the typical redness and blisters occur. After the initial outbreak, subsequent outbreaks tend to be sporadic. They may occur weekly or even years apart.

Genital herpes

Genital herpes

Two types of herpes viruses are associated with genital lesions: herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). HSV-1 more often causes blisters of the mouth area while HSV-2 more often causes genital sores or lesions in the area around the anus. The outbreak of herpes is closely related to the functioning of the immune system. Women who have suppressed immune systems, because of stress, infection, or medications, have more frequent and longer-lasting outbreaks.

It is estimated that as many as 50 million persons in the United States are infected with genital HSV. Genital herpes is spread only by direct person-to-person contact. It is believed that 60% of sexually active adults carry the herpes virus. Part of the reason for the continued high infection rate is that most women infected with the herpes virus do not know that they are infected because they have few or no symptoms. In many women, there are “atypical” outbreaks where the only symptom may be mild itching or minimal discomfort. Moreover, the longer the woman has had the virus, the fewer the symptoms they have with their outbreaks. Finally, the virus can shed from the cervix into the vagina in women who are not experiencing any symptoms.

An estimated 40 million people have genital herpes;

About 500,000 new people get symptomatic herpes each year;

There are even more people without symptoms.

Genital herpes infection:

has increased 30% in the USA;

has increased most dramatically among young white teens (12-19 years old);

among whites is 5 times higher than 20 years ago;

is twice as likely to infect 20-29 year old adults.

Genital herpes transmission

Herpes is spread by direct contact including:

  • Sexual contact (vaginal sex, anal sex, oral sex);
  • Skin-to-skin contact including kissing;

Genital herpes

  • Can be transmitted with or without the presence of sores or other symptoms;
  • Is often transmitted by people who do not realize infection can be passed on even when there are no symptoms;
  • Is often transmitted by people unaware they are infected.

Once you have a herpes infection, you probably cannot be infected again by the same strain of herpes virus.

Herpes symptoms

When a person is infected with the herpes virus, it may pass unnoticed. This is called subclinical infection. Usually the herpes virus retreats into the nerves and lies dormant. Even when there are no symptoms of herpes, transmitting the virus is still possible (asymptomatic viral shedding). Therefore many people with genital herpes are not aware they have the infection.

When symptoms occur, they appear from time to time in episodes (also called outbreaks or attacks). After contracting the herpes virus, a person may experience an episode within a few days, but it may take much longer (sometimes years) before symptoms are noticed. When it gets into skin cells the virus reproduces itself and starts to multiply, making the skin red and sensitive. Often, the person never develops recognizable herpes symptoms.

In the first episode (usually within 2-20 days after contact) the following symptoms could occur:

  • feeling unwell – flu-like symptoms;
  • fever,
  • headaches,
  • lower back pain and/or pain in legs,
  • vaginal discharge,
  • burning sensation in the genitals,
  • burning sensation and/or pain when urinating,
  • muscle ache,
  • swollen lymph glands,
  • small red bumps may appear in the genital area after initial symptoms, which later develop into painful blisters (which develop around the infected area) – the blisters first opening and then healing with the regeneration of new skin tissue.

The first episode is the most severe, with most episodes lasting 10-21 days.

Most genital herpes outbreaks cause symptoms similar to the cold sores that many people experience on or around their lips. But with genital herpes, the “cold sores” usually appear on or near the genitals or anus. Sometimes they appear on the buttocks or thighs.

Outbreaks may produce small blisters, which break open to form shallow painful sores. These develop a scab after 1-2 weeks and then heal. Sometimes the first outbreak causes considerable pain and distress; future episodes are usually less severe. During the outbreak the infected area may be painful, burn, itch and tingle.

Although herpes sores heal, the virus remains in the body and may produce more sores later. These are called recurrent outbreaks.

Diagnosis

Herpes is diagnosed by taking a sample from an infected area during an outbreak. The herpes virus will usually grow from a swab taken from a ruptured blister. The test will identify the strain (type 1 or type 2) of the herpes virus. Type 1 genital herpes tends to cause fewer recurrences than type 2.

Blood tests may assist diagnosis in some cases, but the results can be difficult to interpret. A blood test can only tell that you have been infected with the herpes virus in the past. However, because false-positive results can occur and because the test results are not always clear-cut, they are not recommended for routine use in screening low-risk populations for HSV infection.

Treatment

There is no cure for herpes to date. Supporting your immune system should be your first goal. A weakened immune system is more prone to outbreaks. Efforts to develop a herpes vaccine by biotechnology companies are ongoing. Until an effective herpes vaccine or cure for HSV infection is found, the prevailing approach to treatment continues to be suppressive antiviral therapy.

Since it is caused by a virus, it is self-limiting or may just heal over a period of time. The treatment concentrates on reducing or alleviating the symptoms that the person has. Antiviral drugs may be prescribed to decrease the number of sores and the frequency of their reappearance. Antiviral drugs include aciclovir (Zovirax), famciclovir (Famvir) and valaciclovir (Valtrex) – these drugs prevent the virus from multiplying and even shorten the length of the eruption.

Herpes can be spread from one part of the body to another during an outbreak.

  • Therefore, it is important not to touch the eyes or mouth after touching the blisters or ulcers;
  • Thorough hand washing is a must during outbreaks;
  • Clothing that comes in contact with ulcers should not be shared with others;
  • Couples that want to minimize the risk of transmission should always use condoms if a partner is infected. Unfortunately, even when an infected partner isn’t currently having an outbreak, herpes can be spread.
  • Couples may also want to consider avoiding all sexual contact, including kissing, during an outbreak of herpes;
  • Since an active genital herpes outbreak (with blisters) during labor and delivery can be harmful to the infant, pregnant women who suspect that they have genital herpes should tell their doctor. Women who have herpes and are pregnant can have a vaginal delivery as long as they are not experiencing symptoms or actually having an outbreak while in labor.

Prevention

Transmission of herpes to another person is most likely to occur when you have oral, genital or anal sex a few days before, or during the outbreak. Abstaining from vaginal, anal and oral sex with an infected person is the only 100% effective means of preventing the sexual transmission of genital herpes.

It is possible to transmit infection even if there are no obvious blisters, sores or other symptoms.

Latex condoms can reduce but not eliminate the risk of contracting the disease during sex. When condoms are used properly, they stop transmission of the virus across the skin that they cover. However, it is still possible to contract genital herpes, even while using a condom, via sores in the genital area.

If you do not have any blisters or sores, it is an individual decision whether to use condoms when having sex.

Some people have the misconception that taking birth control pills and using spermicidal agents can prevent them from acquiring sexually transmitted diseases. Pills are only used to prevent pregnancies and spermicidal agents are used to neutralize sperms.

Abstinence or not having sexual intercourse is the safest way to steer yourself away from these diseases. However, if you choose to be sexually active and have the tendency to have more than one partner, it is important that you get yourself tested and protect yourself from being infected by letting your partner undergo tests too.

Herpes and pregnancy

In pregnant women, herpes infection may be transmitted to the baby at delivery, causing serious illness. When active sores are present, normal vaginal delivery may be dangerous to the welfare of the child. This is not common, but the obstetrician should be told of past genital herpes infections so the risk of this complication can be minimized.


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