GENITAL HERPES 

What is genital herpes and how is it spread?

Genital herpes is a viral infection that causes clear blisters that overlie ulcers on the skin or mucosa (lining of the body's openings) of sexually exposed areas. 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 (perianal).

Approximately 3 to 7 days after an initial exposure to herpes, some individuals can experience mild or even no recognized evidence of infection, which then resolves spontaneously. Others can develop severe bouts of painful blisters that can be accompanied by fever and headache. Once a herpes infection occurs, it is life-long and can be characterized by recurrent sporadic outbreaks. The outbreaks occur because the dormant HSV is activated. Outbreaks occur at different rates in different individuals. The recurrences can be associated with stress or other infections. They also occur with increased frequency in those who are immunosuppressed, such as with HIV infection. These outbreaks usually are characterized by mildly to moderately painful clusters of blisters over the infected area. The recurrences usually resolve spontaneously, with the blisters disappearing in about 5 days. HSV in HIV-infected individuals, however, can cause more severe disease, which often causes ulcers rather than blisters and persists for a longer time.

Estimates are that as many as 45 million persons in the United States are infected with HSV-2. Genital herpes is spread only by direct person to person contact. The lesions of herpes are generally visible in men at the time of active disease, when transmission is most likely to occur. In contrast, women can have internal lesions that are not evident to either partner. Moreover, women can shed herpes virus despite having no symptoms of the disease. These women, therefore, can unknowingly place others at risk for infection with herpes.

How is herpes diagnosed?

The diagnosis of genital herpes is usually based upon the appearance of multiple, painful clusters of small blisters over the genital or anal area. The definitive diagnosis is based on a culture of the virus. The culture is done by opening a blister, swabbing the base of the ulcer, and sending the swabbed material to the laboratory for culture. Blood tests that detect antibodies to the HSV reveal whether someone is infected with herpes. These antibodies are proteins that are produced by the body in an immunological (defensive) response specifically targeted against this virus. The antibodies, however, do not indicate whether the person's current lesions are actually due to the herpes or another disease. The antibody test, therefore, is of minimal value in diagnosing genital herpes.

What should persons infected with genital herpes know?

Patients who are newly diagnosed with genital herpes should be aware that there is no cure, that recurrent episodes can occur, and that even when there are no obvious lesions, HSV can be spread to others. Affected individuals should notify their sex partners that they are infected with HSV. They should avoid sexual activity not only when the blisters are present, but also when a pre-outbreak tingling, which sometimes is felt over the involved skin, occurs. Since HSV can be spread even during periods when there are no symptoms, condoms or other latex barriers should be used routinely during sexual contact with an infected person. This should be done even if the condoms are not needed at that time to prevent other STDs or to avoid pregnancy. Women with genital herpes should be aware of the possibility of that HSV can be spread to a newborn if the mother has an outbreak at the time of delivery. Finally, patients should understand the clear, but limited role, of antiviral treatment for the initial outbreak and for subsequent outbreaks and for suppressive therapy to prevent recurrences in patients with frequent outbreaks.

How is genital herpes treated?

Several antiviral drugs have been used to treat HSV infection. Although topical (applied directly on the lesions) agents exist, they are generally less effective and are not routinely used. Medication that is taken by mouth, or in severe cases intravenously, is more effective. Patients need to understand, however, that there is no cure for genital herpes and that these treatments only reduce the severity and duration of outbreaks.

Since the initial infection with HSV tends to be the most severe episode, antiviral treatment usually is warranted. In contrast, recurrent episodes tend to be mild and the benefit of antiviral medications is only derived if therapy is started immediately prior to the outbreak or within the first 24 hours of the outbreak. In order to benefit patients with recurrences, the drug must be provided for the patient in advance. The patient is instructed to begin treatment as soon as the familiar pre-outbreak tingling sensation occurs or at the very onset of blister formation. Finally, suppressive therapy to prevent frequent recurrences may be indicated for those with more than 6 outbreaks in a given year.

The treatment options for HSV include:

 

What should a person do if exposed to someone with genital herpes?

People who have been exposed to someone with genital herpes should obtain counseling about its symptoms, the nature of the outbreaks, and how to prevent acquiring or transmitting herpes in the future. If the exposed person experiences an outbreak of herpes, he or she should be further evaluated and then treated as indicated.