Genital Herpes

What causes genital herpes infections?

Genital herpes is caused by the herpes simplex virus (HSV) and may affect the genital area (usually HSV-2) or the mouth and lips (usually HSV-1). Genital herpes is transmitted by vaginal or anal sex; the virus enters the body through tiny cuts in the skin or mucous membranes.

Herpes simplex virus is one member of the herpes group of viruses. Other types of herpes virus cause chickenpox, shingles, cold sores or fever blisters, and mononucleosis. About 80 percent of the U. S. population carries at least one form of herpes virus.

How common is herpes?

It has been estimated that as many as 35-40 million Americans carry the genital herpes virus. That is roughly one sixth of the U. S. population between the ages of 15 to 75.

What are the symptoms of genital herpes?

When you are first infected, you may have non-specific symptoms, such as fever, muscle pain, headaches, lethargy, or swollen lymph nodes. These initial symptoms start two days to three weeks after initial exposure. However, the most well recognized feature is burning and itching of a seemingly normal spot on the skin, followed by an eruption of painful blisters. These fluid-filled sores rupture soon after they appear and the fluid oozes out. The sores crust over and heal without leaving a scar. Eruptions can occur anywhere on the skin, but they usually are found where the virus entered your body. In rare cases, one might have a vaginal or urethral discharge or even difficulty urinating. Many patients have NO symptoms at all.

How is the diagnosis of herpes made?

The initial symptom of HSV-2 is pain or itching of the skin around the genital area. This stage is known as the prodromal period and begins 2-20 days after exposure to the virus. Anywhere from a few hours to several days after the prodromal stage, sores begin to appear. In men the lesions are on the penis, scrotum, buttocks, anus, and thighs. In women the lesions are on the labia, vagina, cervix, buttocks, anus, and thighs. Sores may be present, but invisible inside the urethra (the urinary channel leading out to the bladder). While the ulcers are present, it may be painful to urinate. The ulcers begin as small, tender, red bumps and become watery blisters within a few days. They then rupture, becoming ulcers that ooze or bleed. After three-to-four days, scabs form and the ulcers heal. You may experience pain and tenderness in the genital area until the infection clears. The diagnosis can be confirmed by culturing the water blisters or early ulcers. A thorough examination for other sexually related diseases is important. Often, other sexually transmitted diseases are present in addition to herpes.

What is the treatment for herpes?

During the initial outbreak, acyclovir or famciclovir, in oral form help speed up healing (in some patients). This initial treatment does not prevent recurrences. However, if recurrences are frequent, acyclovir or famciclovir can be used for a long time to suppress the herpes virus.

How can herpes be prevented?

So far, no method has been found to destroy herpes simplex virus. It remains dormant in nerve tissue until something stimulates a flare-up. Exposure to sunlight or emotional or physical stress may provoke eruptions, and you may notice other stress that aggravates the problem. Use of sunscreens, eating well, and avoiding fatigue are often helpful. Keeping sores dry may make you more comfortable. Avoid skin-to-skin contact with others when the infection is active.

Will the herpes come back?

Recurrences vary greatly among patients but about 80-90 percent of patients with genital herpes will have recurrent outbreaks. Usually the first recurrence will happen within six months. If episodes are frequent or severe, you may benefit from use of special medications that your doctor can prescribe (usually Zovirax or acylovir). Support groups are available and can be a source of information, understanding, and comfort.

How can I treat the recurrences?

If the recurrences are frequent, acylovir can be used as prophylaxis to lessen the frequency. Four hundred milligrams twice a day, every day is the most usual regimen. Famciclovir can also be used. Re-evaluation of treatment should be done every year.

Some patients take acylovir only at the first signs of outbreak. Usually 400 milligrams taken five times a day for 10 days is used. This seems to reduce the severity of the outbreak.

How can I protect my partner if I have herpes?

Herpes is very contagious when the sores are present--that means the virus is being "shed"; even at the first signs of recurrence before the blister stage virus is present in large numbers. Abstain from sexual contact until the outbreak is completely healed-the blisters are gone and the skin looks normal. Using a condom during sexual intercourse probably reduces the risk of acquiring the infection. In most cases, the virus is not being "shed" when no sores are present-but not always! Using latex condoms (better than natural membrane) and spermacides (with Nonoxynol-9 - look at the box for ingredients) at all times is probably the safest way to prevent infecting your partner.

How can I avoid getting herpes?

A monogamous sexual relationship is the surest way of avoiding the disease (assuming your partner doesn't have herpes).

What other information is important to know?

If you are pregnant, be sure to tell your doctor if you have ever had genital herpes. Infants can be infected during delivery, even though the mother has no obvious sores at the time. Women who have had genital herpes may have to deliver by a Cesarean section. The virus cannot live outside the body, so it cannot be spread through contact with toilet seats or doorknobs. (Some old-wives tales never die, but herpes does once exposed to air).