Genital Herpes

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Genital Herpes : Overview Genital Herpes : Diagnosis
Genital Herpes : Background Genital Herpes : Treatment
Genital Herpes : Risk Factors Genital Herpes : Prevention
Genital Herpes : Signs and Symptoms Genital Herpes : Prognosis
Genital Herpes : Complications Genital Herpes : References

Overview

Genital HerpesYou may think that you are not at risk for genital herpes since you are not promiscuous and use condoms regularly. But genital herpes is more common than you think. Approximately 1 in 6 American teenagers and adults are infected. Condoms can certainly reduce the risk of transmission, but they do not provide complete protection. There is no cure for genital herpes. Although the infection is not life threatening, there are a few potentially serious complications, so it is wise to take precautions.

Background

Genital herpes is a very common sexually transmitted infection caused by the herpes simplex virus (HSV). About 776,000 new cases of genital herpes occur in the U.S. each year, according to an analysis published by the Centers for Disease Control (CDC) in February 2013. There is no cure for genital herpes. Once a person is infected, the virus stays in the body forever. Most of the time, the virus is suppressed by the body’s immune system, but the virus may start reproducing again at any time.

There are two different strains of herpes simplex viruses – type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2, while most oral herpes is caused by HSV-1. However, both viral types can cause either genital or oral infections. HSV-1 genital herpes has been increasing in recent years, possibly due to the increase in oral sex activity among young adults.

Genital herpes is transmitted from person to person through vaginal, oral, or anal intercourse. Actual penetration is not necessary – the virus can be spread by any skin-to-skin genital contact, including sexual foreplay. The risk of infection is greatest when there are open blisters or sores; however, the virus can be spread even when there are no visible symptoms. Genital herpes can also be transmitted from a pregnant woman to her baby during childbirth.

The word “herpes” is derived from a Greek word meaning “to creep”. This refers to the tendency of herpes sores to creep over the surface of the skin. Herpes infections have been referenced in history since ancient Greek times. Hippocrates wrote about the symptoms of herpes lesions in 460 B.C. Later, in Roman times, Emperor Tiberius tried to control a herpes outbreak by banning kissing at public ceremonies. Even Shakespeare is said to have mentioned herpes in his famous work Romeo and Juliet (“O’er ladies lips, who straight on kisses dream, which oft the angry Mab with blisters plagues, because their breaths with sweetmeats tainted are”). During early times, treatments involved using various herbs, bismuth and starch poultices, and even burning off lesions.

It wasn’t until the 1970’s that herpes became acknowledged as a sexually transmitted disease. In 1978, Acyclovir, the first antiviral prescription treatment, was developed by Gertrude Elion and tested on humans. In the 1980’s, anti-viral treatments for oral and genital herpes became available on the market. However, there is still no cure for HSV.

Risk Factors

Except for people in monogamous relationships with uninfected partners, everyone who is sexually active is at risk for genital herpes. Both men and women are susceptible, although women are at higher risk, since the virus is more easily transmitted from men to women than from women to men. About 1 in 4 women have an HSV-2 infection compared to almost 1 in 8 men. African-American women are at particularly high risk.

Other risk factors for genital herpes include a history of a prior sexually transmitted disease, early age for first sexual intercourse, and a high number of sexual partners. Lower socioeconomic class also appears to be a risk factor.

People with HIV or other diseases that weaken the immune system are at greater risk of becoming infected with genital herpes and may develop more severe health problems as a result of the infection. Chemotherapy and immune-suppressing drugs (for transplants or auto-immune diseases) are also risk factors.

Signs and Symptoms

Symptoms of genital herpes vary depending on whether the outbreak is initial or recurrent. The initial outbreak is typically more severe than recurrent outbreaks. However, even during the initial outbreak, many people have very mild symptoms or no symptoms at all.

In the initial (primary) outbreak, people usually experience itching or tingling in the affected area (around the genitals or rectum) with clusters of small red bumps that develop into blisters. These symptoms usually occur 1-2 weeks after exposure to the virus. Over the next few weeks, the blisters break, leaving tender open sores that may take up to 4 weeks to heal. If the blisters are in the area of the urethra, people may have difficulty in urination or a burning sensation when the urine comes in contact with a sore. Some people may experience other symptoms such as headache, muscle pain, fever, loss of appetite, and swollen glands. In rare cases, symptoms are so severe and disabling that they require prompt medical care.

Another outbreak can occur weeks or months later. It is almost always less severe and shorter in duration than the initial outbreak. For many people, the initial symptom is a tingling or itch in the genital area. This may be followed by 7-10 days of blisters. Sometimes recurrences can be triggered by factors such as sunlight, physical illnesses, excess alcohol, or stress. But often the dormant virus erupts for no apparent reason.

Typically, people have about 4 recurrences during the first year. Over time, recurrences become less frequent.

Complications

In most circumstances, genital herpes is not life threatening, although it can cause great emotional turmoil. However, there are a few potentially serious complications.

Studies suggest that genital herpes may increase the risk of contracting HIV (the virus that causes AIDS). This is because open herpes sores on the genitals make it easier for the HIV virus to enter the body.

Pregnant women who are infected with either HSV-2 or HSV-1 have a higher risk for miscarriage, premature labor and retarded fetal growth. In addition, pregnant women can pass the virus to their babies during the birthing process. Transmission to the baby generally occurs only when the mother acquires the virus for the first time late in pregnancy and when the baby passes through the birth canal. Therefore, a Cesarean section is usually done when a woman is having an active herpes outbreak in the genital area. Herpes in newborn babies (congenital herpes) is rare but very serious. It can cause skin rash, blisters, fever, irritability, and eye infections. If left untreated, it can result in brain damage, blindness, or even death.

Genital herpes can occasionally cause bladder problems. The herpes sores can lead to inflammation around the urethra, requiring catheterization to drain the bladder. Genital herpes can also cause rectal inflammation (proctitis), especially in men who have sex with men. Symptoms of proctitis are pain, bleeding, fever, and chills.

Genital herpes can also lead to herpes meningitis, an inflammation of the protective membranes covering the brain and spinal cord. Symptoms include headache, fever, stiff neck, nausea, vomiting, confusion, and sensitivity to light. Fortunately, herpes meningitis typically resolves without any serious issues.

A very rare but extremely serious complication is herpes encephalitis, when the HSV virus spreads to the brain. Initial symptoms are headaches, fever, confusion, and seizures. Herpes encephalitis is fatal in nearly 70% of circumstances. Even those who recover usually suffer permanent damage, ranging from mild impairment to the nervous system to paralysis.

Diagnosis

The best way for a health care professional to diagnose genital herpes (both HSV-1 and HSV-2) is to perform a laboratory analysis on a sample from a fresh herpes sore. However, because not everyone with herpes has symptoms, a blood test may be performed to detect antibodies to the herpes viruses. A blood test can specify whether you are infected with HSV-1 or HSV-2, but it cannot predict what part of the body the virus will affect.

Treatment

Although there is no cure for genital herpes, the infection can certainly be treated. Antiviral drugs, including acyclovir, valacyclovir, and famciclovir, can reduce the severity of symptoms, shorten the duration, decrease the frequency of recurrent outbreaks, and sometimes prevent outbreaks from occurring entirely. All of these medications are available in pill form. They work by stopping the virus from replicating. They do not clear the virus from the body, and they do not have any effect after you stop taking the medication. Acyclovir (Zovirax) is the oldest of the three medications and is the least expensive. Valacyclovir (Valtrex) contains acyclovir as its active ingredient but can be advantageous since it is better absorbed and has fewer side effects. Famciclovir (Famir) has a different active ingredient which is also well-absorbed.

For a first episode of genital herpes, treatment is most effective when initiated within a few days of initial symptoms. A five-day course of treatment is typical, but may be extended by a few days if blisters are still forming. For recurrences, symptoms are often much milder, so antiviral medications may not be needed. However, if symptoms are severe, then a course of medication can be very useful. Medication should be started as soon as symptoms begin.

For those with frequent recurrences, an option is to take antiviral medication every day as suppressive therapy. In most people who take medication every day, the recurrences are either stopped completely, or their frequency and severity are greatly reduced. This type of therapy may also decrease the risk of transmitting HSV to your sexual partner.

While not effective against the actual virus, other agents can be used to relieve certain symptoms of genital herpes. Pain relievers such as paracetamol (Tylenol) may help to ease pain. Anesthetic ointments may also relieve itching or pain. Warm baths or ice packs may be soothing, especially when open sores are present.

It is possible that maintaining a healthy lifestyle can offer some protection against herpes outbreaks (since it has been shown that stress and illness can weaken the immune system, making a person more susceptible to the infection). However, this has not been verified. Some people claim that certain supplements or other alternative approaches can successfully treat or prevent herpes, but the CDC does not endorse these approaches.

Prevention

Because genital herpes is transmitted during sexual activity, the most reliable way to prevent infection is to abstain from oral, vaginal, and anal sex or to have a mutually monogamous relationship with an uninfected sex partner.

When used consistently and correctly, male condoms or other latex barriers can lower the risk of transmission. Condoms should be used for all types of sexual contact, even if penetration does not occur, and a new condom should be used after each ejaculation. People with genital herpes should use condoms at all times, even when there are no visible blisters and no symptoms.

Most other birth control methods – including the pill, IUD, diaphragm, and spermicides – don’t protect against genital herpes and other STDs. However, there is evidence that washing with soap and water after sex might reduce the risk of contracting genital herpes. The herpes virus is surrounded by a lipid (fatty) coating, which causes it to be inactivated by soap.

During an active outbreak of genital herpes, sexual intercourse should be avoided until all sores and blisters have cleared.

Prognosis

Genital herpes remains a serious public health concern. Since most infected persons are asymptomatic, a very high proportion of HSV infections are unrecognized by both patients and health care professionals. Do we need more routine screening for the general population? According to the CDC, there is no conclusive evidence that more widespread screening will reduce the spread of infection. Genital herpes causes an incurable, lifelong infection, so early detection will not result in a cure as it will with other STDs like syphilis, gonorrhea, and chlamydia. In addition, screening is expensive and could result in false positives which could have adverse psychological effects. So what can be done to improve outcomes? Better sex education is certainly needed, as well as making condoms available to sexually active youth. Persuasive prevention campaigns, including efforts to delay initial sexual encounter, may also be beneficial.

References:

1) Genital Herpes – CDC Fact Sheet
Source: Centers for Disease Control and Prevention

2) Incidence, Prevalence, and Cost of STI in the United States – CDC Fact Sheet
Source: Centers for Disease Control and Prevention

3) Genital Herpes Fact Sheet
Source: Womenshealth.gov

4) Everything You Need to Know About Herpes
Source: MIT Medical

5) Genital Herpes
Source: Aetna InteliHealth

6) Sexually Transmitted Diseases
Source: The Center for Menstrual Disorders and Reproductive Choice

7) Herpes Simplex
Source: University of Maryland Medical Center

8) Sexually Transmitted Diseases
Source: Male Health Center

Posted in STI.