Genital herpes

Genital herpes is a sexually transmitted viral infection affecting the skin or mucous membranes of the genitals. Causes Genital herpes is caused by two viruses:

Herpes simplex virus type 2 (HSV-2) Herpes simplex virus type 1 (HSV-1)

Herpes simplex virus type 2 (HSV-2) causes most cases of genital herpes. HSV-2 can be spread through secretions from the mouth or genitals. Herpes simplex virus type 1 (HSV-1) most often causes herpes infections of the mouth and lips (commonly called cold sores or fever blisters). HSV-1 can spread from the mouth to the genitals during oral sex. Herpes simplex virus (HSV) is spread from one person to another during sexual contact. You may be infected with herpes when your skin, vagina, penis, or mouth comes into contact with someone who already has herpes. Herpes is most likely to be transmitted by contact with the skin of an infected person who has visible sores, blisters, or a rash (an active outbreak), but you can also catch herpes from an infected person's skin when they have NO visible sores present (and the person may not even know that he or she is infected), or from an infected persons mouth (saliva) or vaginal fluids. Because the virus can be spread even when there are no symptoms or sores present, a sexual partner who has been infected with herpes in the past but has no active herpes sores can still pass the infection on to others. Genital HSV-2 infections is more common in women (approximately 1 of every 4 women is infected) than it is in men (nearly 1 of every 8 men is infected). Symptoms Many people with HSV-2 infection never have sores, or they have very mild symptoms that they do not even notice or mistake for insect bites or another skin condition. If signs and symptoms do occur during the first outbreak, they can be quite severe. This first outbreak usually happens within 2 weeks of being infected. Generalized or whole-body (systemic) symptoms may include:

Decreased appetite Fever General sick feeling (Malaise) Muscle aches in the lower back, buttocks, thighs, or knees

Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid. They are usually found:

In women: on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks In men: on the penis, scrotum, around the anus, on the thighs or buttocks In both sexes: on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body Before the blisters appear, the person may feel the skin tingling, burning, itching, or have pain at the site where the blisters will appear When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days or more

Other symptoms that may occur include:

Enlarged and tender lymph nodes in the groin during an outbreak Painful urination Women may have vaginal discharge or, occasionally, be unable to empty the bladder and require a urinary catheter

A second outbreak can appear weeks or months after the first. It is almost always less severe and shorter than the first outbreak. Over time, the number of outbreaks may decrease. Once a person is infected, however, the virus hides within nerve cells and remains in the body. The virus can remain "asleep" (dormant) for a long period of time (this is called latency). The infection can flare-up or reactivate at any time. Events that can trigger latent infection to become active and bring on an outbreak include:

Fatigue Genital irritation Menstruation Physical or emotional stress Trauma

Attacks can recur as seldom as once per year, or so often that the symptoms seem continuous. Recurrent infections in men are generally milder and shorter than those in women. Exams and Tests

Tests can be done on skin sores or blisters to diagnose herpes. These tests are most often done when someone has a first outbreak and when a pregnant women develops genital herpes symptoms.

Culture of fluid from a blister or open sore may be positive for herpes simplex virus. The herpes simplex virus can in the culture in 2-3 days. It is most useful during the first outbreak. A test called PCR performed on fluid from a blister shows small amounts of DNA. It is the most accurate test to tell whether the herpes virus is present in the blister. Blood tests check for antibody levels to the herpes virus. These blood tests can identify whether someone has ever been infected with the herpes virus, even between outbreaks. It may be positive even if they've never had an outbreak.

Treatment Genital herpes cannot be cured. However, antiviral medication can relieve pain and discomfort during an outbreak by healing the sores more quickly. These drugs appear to help during first attacks more than they do in later outbreaks. Medicines used to treat herpes include acyclovir, famciclovir, and valacyclovir. For repeat outbreaks, start the medication as soon as the tingling, burning, or itching begins, or as soon as you notice blisters. People who have many outbreaks may take these medications daily over a period of time. This can help prevent outbreaks or shorten their length. It can also reduce the chance of giving herpes to someone else. Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby. Possible side effects from herpes medications include:

Fatigue Headache Nausea and vomiting Rash Seizures Tremor

Home care for herpes sores:

Do NOT wear nylon or other synthetic pantyhose, underwear, or pants. Instead, wear loose-fitting cotton garments Gentle cleansing with soap and water is recommended. Taking warm baths may relieve the pain (afterward, keep the blisters dry)

If one of the sores develops an infection from bacteria, ask your doctor if you need an antibiotic. Genital Herpes Table of Contents

Definition Description Causes Symptoms Diagnosis Treatment Questions Prevention Definition Article updated and reviewed by David Aronoff, M.D., Assistant Professor, Division of Infectious Diseases, University of Michigan Medical School on May 9, 2005. herpes simplex virus (HSV) and is one of the most common sexually transmitted diseases (STDs). Description There are two types of HSV, HSV-1 and HSV-2. HSV-1 is usually responsible for cold sores (fever blisters) of the lips and mouth. HSV-2 is the one that most commonly causes genital herpes. The infection causes painful, ulcerative sores on the genitals in both men and women. However, HSV-1 can cause genital herpes, and HSV-2 can cause cold sores. Genital herpes is common. In the United States, one out of five of the total adolescent and adult population is infected with HSV. Causes Herpes is spread by direct contact with an infected person. For example, if you have genital herpes and have sexual intercourse, you can give your partner genital herpes. If you have oral herpes, you can give your partner oral herpes while kissing, and you can also give it to your partner during oral sex. Symptoms Symptoms of genital herpes can vary. Many individuals infected have few, if any, noticeable symptoms.

In people who do have symptoms, the symptoms start 2 to 20 days after exposure to someone with HSV infection. Symptoms may last for several weeks. The first episode of genital herpes is usually worse than subsequent outbreaks. The following symptoms may occur during the first episode of herpes:

Painful bumps or blisters that break open and form ulcers in the genital area Itching, tingling, or burning sensation of the skin Swollen, tender glands (lymph nodes) around the genital area General flu-like symptoms, including muscle aches Headache Vaginal discharge Painful urination

Following the primary infection, HSV-2 infects nerve cells, which allows the virus to remain indefinitely in a dormant state within the body. Sporadic reactivation of the virus can occur resulting in a recurrence of lesions on the genitalia. In fact, most infected persons with genital herpes have five to eight outbreaks per year, but not everyone has recurrent symptoms. As time goes on, the number of outbreaks usually decreases. Sores typically come back near the site of the first infection. Usually, as the outbreaks recur, there are fewer sores and they heal faster and are less painful. Recurrent outbreaks of herpes can be triggered by illness, stress, fatigue, menstruation, sunburn, or sexual intercourse. Diagnosis Diagnosis can be based on the medical history, including symptoms and a physical examination. However, lesions may have an atypical appearance and other diseases may mimic typical HSV. Therefore, infection by HSV is best confirmed in the laboratory either by demonstration of HSV DNA in scrapings or tissue from lesions or by isolation of virus in tissue culture. HSV DNA detection has been shown to be more sensitive than viral isolation and is less affected by problems in specimen transport. Treatment Currently, there is no cure or vaccine for herpes infections. Once HSV enters the body, it is a lifelong resident that is capable of causing recurrent attacks. Emotional stress, fatigue, excessive exposure to sun or wind, skin friction, menstruation, and physical trauma have all been implicated as possible triggers of recurrent episodes. But, it is still unclear how the dormant virus is reactivated and just what triggers this process. For years no effective drug therapy for herpes infections was available, and patients simply had to wait for episodes to resolve naturally. At least three medications are now available for treatment of herpes infections. They are acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). All three agents are very effective. Typically, these drugs are prescribed during active outbreaks, and may not be needed for mild cases. Long-term drug therapy (suppressive treatment) may be helpful for individuals who suffer frequent recurrent outbreaks. Suppressive treatment will reduce outbreaks by 85 percent and reduces viral shedding by more than 90 percent. Topical antibiotic ointments also may be applied to prevent secondary bacterial infections. During an outbreak of genital herpes, a number of measures should be taken to make the patient more comfortable:

Wear loose clothing Avoid excessive heat or sunlight Keep the sore area clean and dry Place cool or lukewarm cloths on the sore area for short periods of time Do not use perfumed soaps, sprays, feminine deodorants, or douches Take aspirin, acetaminophen or ibuprofen for the pain Avoid touching sores Wash hands if you do touch the sores<//li>

Questions What treatment do you prescribe? What are the side effects? Do I need 'suppressive treatment'? What else can be done to reduce the pain and discomfort? What preventive measures should be taken to avoid spreading HSV infection? ________________________________________ Editorial review provided by VeriMed Healthcare Network. ________________________________________ Prevention To reduce the risk of spreading HSV to others, it is important to avoid intimate contact when sores are on the body. Itching, burning or tingling may occur just before the sores develop. Sexual intercourse should be avoided during this time. Herpes can even be spread when there are no sores or symptoms. To minimize the risk of spreading herpes, latexcondoms should be used during all sexual contact. Spermicidal foams and jellies may offer added protection.

HSV can also be spread by touching the sores and then touching another part of the body. If you touch the sores, wash your hands with soap and water as soon as possible. Also, do not share towels or clothing with anyone. Babies can be infected with the herpes virus, which can have devastating consequences for the newborn. If you are pregnant or considering having children, you should tell your health care provider if you have ever been exposed to anyone with herpes, even if you have never had any symptoms. Your health care provider can take special precautions at the time of delivery to protect the baby from getting infected with herpes