Genital Herpes: The Gift That Keeps on Giving
Genital herpes is a sexually transmitted disease caused by 2 viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral-to-oral contact, and is commonly referred to as “cold sores” or “fever blisters”. While most people become infected with HSV-1 during childhood or young adulthood from saliva (non-sexual contact), many have no symptoms. Genital herpes is almost exclusively sexually transmitted (HSV-2), but can also be caused by HSV-1 through oral sex.
Genital herpes (HSV-2) infection is common in the U.S.
· 15.7 % of persons aged 14 to 49 years have HSV-2 infection (however, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1)
· HSV-2 infection is more common among women than among men (20.3% vs 10.6% in 14 to 49 year olds), possibly because the genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex
· Most infected persons may be unaware of their infection. In the U.S., an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never been diagnosed
Transmission of Genital Herpes
· Contact with HSV from herpes lesions, mucosal surfaces (lining of the mouth, vagina, and anus), genital secretions, and oral secretions
· HSV-2 can be shed from normal-appearing genital mucosa or skin
· Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that they are infected
· The average incubation period for an initial herpes infection is 4 days
Symptoms: Painful or burning blisters or sores on or around the genitals or rectum
· The blisters break and leave painful ulcers that may take 2 - 4 weeks to heal
· The first outbreak of genital herpes is associated with a longer duration of lesions, increased shedding of the virus (making HSV transmission more likely), and body symptoms including fever, body aches, swollen lymph nodes, or headache
· Symptoms before the blisters and ulcers appear: localized genital pain or tingling, or shooting pains in the legs, hips or buttocks which occur hours to days before the eruption of lesions
· Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes
Diagnosis: Testing options can determine if the infection is a result of HSV-1 or HSV-2, although this will not affect the treatment.
· Viral culture: requires collection of a sample from the lesion
· HSV DNA PCR: requires collection of a sample from the lesion. It is more sensitive, and allows for more rapid and accurate results than the viral culture
· Blood test that detect antibodies to the herpes virus: If this test is negative and a primary infection is still suspected, repeat the test in 6 to 12 weeks (it may take the body 12 weeks to make antibodies that can be found in the blood test)
· Painful genital ulcers can be severe and persistent in persons with suppressed immune systems, such as with HIV/AIDS or cancer
· HSV-2 infection increases the risk of acquiring HIV by approximately three-fold
· Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. The risk is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants
· Recurrent symptoms of genital herpes may be painful and the infection can lead to social stigma and psychological distress. These factors can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection
Treatment: Anti-viral medications (acyclovir, famciclovir, and valacyclovir) are the most effective treatment available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.
· Correct and consistent use of latex condoms can reduce, but not eliminate, the risk of transmitting or acquiring genital herpes because herpes virus shedding can occur in areas that are not covered by a condom
· Abstain from sexual contact, or be in a long-term mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected
· Persons with herpes should abstain from sexual activity with partners when herpes lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, they can still infect sex partners. Sex partners of infected persons should be advised that they may become infected, and they should use condoms to reduce the risk
· Daily treatment with an anti-viral medication decreases the rate of HSV-2 transmission