Genital herpes is a sexually transmitted disease caused by a herpes virus characterized by painful blisters on the genital areas of men and women. It is spread person-to-person by sexual contact. It is not spread by toilet seats, doorknobs, swimming pools, hot tubs, or through the air. At present, there isno vaccine or cure.
There are eight kinds of human herpes viruses. Only two of these (herpes simplex types 1 and 2) cause genital herpes. Although it is commonly believed that herpes simplex virus type 1 causes only cold sores and herpes simplex virustype 2 causes only genital sores, this is not completely true. Both herpes virus type 1 and type 2 can cause herpes sores on either the lips or genitals.
Sometimes an active infection occurs without visible sores. An infected person can therefore spread herpes virus to other people without knowing it. The initial infection, known as the "primary" infection, can be followed by laterrecurrent infections.
The first symptoms of herpes usually occur within two to seven days after contact with an infected person, but they may take up to two weeks to appear. For up to 70% of patients, the symptoms may affect the whole body, triggering tiredness, headache, fever, chills, muscle aches, loss of appetite, as well aspainful, swollen lymph nodes in the groin.
Most patients with genital herpes experience symptoms of oncoming disease (aprodrome) of pain, burning, itching, or tingling at the site where blisters will form. This stage may last anywhere from a few hours, to one to two days.The prodrome can occur before a first-time infection, or in recurrent infections. The prodrome for recurrent infections may be severe and cause a severe burning or stabbing pain in the genital area, legs, or buttocks.
Following the prodrome come the herpes blisters. In dry areas, the blisters become covered with a scab and heal within two to three weeks. In moist areas,the blisters burst and form painful ulcers that heal within three to four weeks. In men, herpes blisters usually form on the penis but can also appear onthe scrotum, thighs, and buttocks. In women, they most often appear on the labia and entrance to the vagina, but can also form on the buttocks, thighs, breasts, fingers, eyes, and around the urinary and anal openings.
Thirty percent to 40% of men have a discharge from the urinary tube. Men mayalso experience painful or difficult urination (44%), swelling of the urinarytube (27%), meningitis (13%), and throat infection (7%).
Women can experience a very severe and painful primary infection. Herpes blisters first appear on the labia and vaginal area, causing a watery discharge.Other symptoms may include painful or difficult urination (83%), swelling ofthe urinary tube (85%), meningitis (36%), and throat infection (13%). One inten women also gets a vaginal yeast infection.
After the primary infection, the virus does not disappear, but goes into hiding in the cells. At some point, these "latent" viruses may become activated again and cause a recurrent infection.
Most of the time, herpes infections don't cause serious health problems, although they may be inconvenient, mildly uncomfortable, or psychologically stressful. However, an active lesion during childbirth can cause serious problemsfor a newborn baby. While a recurrent herpes flareup during pregnancy will not likely harm the unborn child, a lesion in the genital area during birth itself can transmit the virus to the newborn. Infants thus infected with herpesvirus experience a very severe, possibly fatal disease called "neonatal herpes infection." For this reason, doctors will perform Cesarean sections on women who go into labor with active genital herpes.
Risk factors for genital herpes include: early age at first sexual activity,multiple sexual partners, and a medical history of other sexually-transmitteddiseases.
About 40% of the persons infected with herpes simplex virus type 2 will experience six or more outbreaks each year. Genital herpes recurrences are less severe than the primary infection; however, women still experience more severesymptoms and pain than men. Blisters will appear at the same sites during each outbreak.
Genital herpes is diagnosed primarily by symptoms, although laboratory testsmay be performed to look for the virus. Because genital sores can be symptomsof many other diseases, the doctor must determine the exact cause of the sores.
Certain antiviral drugs can lessen symptoms and decrease length of herpes outbreaks. Some may also prevent future outbreaks. These drugs are most effective when taken as early in the infection process as possible, preferably duringthe prodrome stage. Acyclovir (Zovirax) is the drug of choice for herpes infection. Other drugs that may be used include famciclovir (Famvir), valacyclovir (Valtrex), vidarabine (Vira-A), idoxuridine (Herplex Liquifilm, Stoxil), trifluorothymidine (Viroptic), and penciclovir (Denavir). Patients with more than six to eight outbreaks per year may benefit from long-term use of acyclovir (called "suppressive therapy"). Alternatively, patients may use short-termsuppressive therapy to lessen the chance of developing an active infection during special occasions such as weddings or holidays.
There are several things that a patient may do to lessen the pain of genitalsores. Wearing loose-fitting clothing and cotton underwear is helpful as is soaking in a tub of warm water and using a blow dryer on the "cool" setting todry the infected area. Applying an ice pack on the affected area (alternating 10 minutes on, 5 minutes off) may relieve pain. A zinc sulfate ointment mayhelp to heal the sores, and using a baking soda compress on the sores may besoothing.
Newborn babies with herpes virus infections are treated with intravenous acyclovir or vidarabine, which have greatly reduced deaths and increased the number of babies who appear normal at one year of age. However, because neonatalherpes infection is so serious, even with treatment some babies may not survive; if they do, some may suffer nervous system damage. Infected babies may betreated with long-term suppressive therapy.
To avoid recurrences of herpes outbreaks, alternative treatments may includea diet that is rich in lysine (found in most vegetables, legumes, fish, turkey, beef, lamb, cheese, chicken, and lysine supplements). Other remedies include herbs such as echinacea and garlic, and red marine algae. Ointments containing zinc sulphate, lithium succinate, glycyrrhizinic acid, vitamin E or teatree oil may also be recommended. In addition, homeopathic remedies are available.
The only way to prevent genital herpes is to avoid contact with infected people. This is not easy, because many people are not aware that they are infected. People who carry the infection should avoid all sexual contact during a herpes outbreak. However, because herpes can spread at any time (even if no active lesions are present), condoms are recommended during sex. As of 1999 no herpes vaccines had been approved, although new vaccines are being tested in humans.