Genital herpes - symptoms, treatment, causes and spreading

What is Genital Herpes

Genital herpes - a sexually transmitted disease (STD) resulting from INFECTION with herpesvirus, usually HERPES SIMPLEX VIRUS 2 (HSV-2). Herpes simplex virus 1 (HSV-1), which causes cold sores, may also cause sores in the genital area. Genital herpes is one of the most prevalent STDs in the United States, infecting about 25 percent of teens and adults-more than 45 million people. About 1 million new infections occur each year.

Progression of Genital Herpes

As is characteristic of the herpesviruses, HSV-2 remains in the body for life after the initial infection, retreating to NERVE roots within the areas of infection. Periodically the virus travels along the nerves to the surface of the SKIN, causing outbreaks of blisters that become crusted sores. During these outbreaks the virus both replicates and sheds, and the infected person is highly contagious. Such a pattern of REMISSION and RECURRENCE continues through life; there currently is no cure for genital herpes.

Spreading Genital Herpes

Direct contact with SEMEN, vaginal fluids, and saliva spreads genital herpes from one person to another during vaginal intercourse, anal intercourse, or oral sex. The infection does not spread via contact with objects such as toilet seats or in water (such as swimming pools and hot tubs). Genital herpes is contagious even when no sores are present. Because symptoms may be mild, or in women occur within the VAGINA, many people do not know they have genital herpes. The first outbreak of symptoms tends to be the most severe. Over time outbreaks tend to become less frequent with fewer and smaller sores.

Symptoms of Genital Herpes (in women and men) and Diagnostic Path

Symptoms, when they occur, begin about two weeks after sexual contact with an infected person who is shedding the virus. Initial symptoms may include

tingling, burning, or pain at the site of infection (PENIS, vagina, CERVIX, ANUS, RECTUM, MOUTH, and sometimes on skin surfaces)
FEVER
HEADACHE
swollen LYMPH nodes near the site of the infection
vaginal discharge in women
painful URINATION in men

The hallmark symptom of genital herpes is painful sores that begin as red bumps that BLISTER and then crust. The sores appear at the sites where the virus entered the body and are usually most severe with the first outbreak. Symptoms of subsequent outbreaks tend to be more mild, though sores may appear in new locations as the virus spreads along nerve paths. The sores are present for three to four weeks and then heal without scarring. Periods of remission during which there are no sores or other symptoms may last several weeks to several months.

Health-care providers generally presume a diagnosis of genital herpes when the characteristic sores are present in a person who is sexually active. BLOOD tests can detect the presence of HSV antibodies but this is not especially useful information from a diagnostic perspective because more than 90 percent of people have some sort of herpesvirus infection-herpes simplex, HERPES ZOSTER, varicella (CHICKENPOX)-that activates the ANTIBODY response and blood tests cannot distinguish among the type of herpesvirus present. Cultures of the sores may produce HSV-2, which confirms the diagnosis. However, cultures of the sores may sometimes be negative even when HSV-2 infection is present.

Genital herpes: Treatment Options and Outlook

The sores that erupt during a genital herpes outbreak will heal without treatment within two or three weeks. ANTIVIRAL MEDICATIONS can shorten the length of the outbreak and reduce the number and severity of the sores. Some people benefit from taking an antiviral medication daily, which may lessen the frequency of outbreaks. Valacyclovir is the medication doctors most commonly prescribe for regular use. Antiviral medications do not cure genital herpes, however.

ANTIVIRAL MEDICATIONS TO TREAT GENITAL HERPES
acyclovir	famciclovir	valacyclovir

Most people who have genital herpes experience outbreaks of symptoms several times a year. Stress, MENSTRUATION, and other viral infections such as COLDS seem to trigger outbreaks though symptoms may erupt without apparent cause. The open sores of genital herpes create increased risk for infection with HIV. A pregnant woman can pass genital herpes to her unborn child; doctors may recommend CESAREAN SECTION (surgical delivery) for women whose infections are active (symptomatic) near the time of delivery to prevent this.

Risk Factors and Preventive Measures against Genital Herpes

Because HSV-2 infection is so prevalent, all sexually active people are at risk for genital herpes. Uninfected people who are in monogamous relationships with uninfected sexual partners have the lowest risk for infection; uninfected people who have multiple sexual partners or who are in relationships with sexual partners who have genital herpes have the highest risk for infection. At present the most effective means of prevention among sexually active adults is abstinence during outbreaks and barrier protection such as latex condoms during all sexual activity. Barrier protection is not absolute, however, as the HSV-2 virus may infect nerve cells at the skin’s surface that the condom does not cover.

The antiviral medication valacyclovir significantly reduces viral shedding, slowing but not entirely preventing transmission of genital herpes. This preventive measure is most effective in monogamous relationships in which one person has HSV-2 and the other does not. Clinical studies are under way to evaluate a vaccine for genital herpes.