STDs - Herpes

Genital Herpes

What Is Genital Herpes?

Genital herpes is a common, highly infectious disease caused by a virus. It is transmitted from one person to another during sexual activity. Genital herpes causes blisters or groups of small ulcers (open sores) on and around the genitals in both men and women. Genital herpes cannot be cured;  however, there are prescription medications that can treat outbreaks and minimize the symptoms.

  • Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms of an active infection.
  • At least 45 million Americans are infected with the genital herpes virus, with approximately one million new infections each year. As many as 80%-90% of those infected fail to recognize genital herpes symptoms or have no symptoms at all.
  • The highest rates of infection are seen among the poor, those with less education, cocaine users, and those with many sexual partners.

What Causes Genital Herpes?

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1 and HSV-2. Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call "fever blisters" in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same.

  • Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes.

Note: People with herpes may spread the disease even if they do not realize they have an infection. Furthermore, there is strong evidence that people with herpes can transmit infection even while their disease appears to be inactive and no sores can be visibly seen.

  • Many people remember having an episode of genital herpes when it occurs. But as many as 90% of those infected fail to recognize the symptoms or have no symptoms at all. It is not clear whether these people never had an initial herpes outbreak or whether they never noticed a mild infection.
    In these individuals genital herpes is still contagious, and they may have additional outbreaks.

Treatments

Individuals infected with the genital herpes virus should:

  • Avoid excessive heat or sunlight, which makes the irritation more uncomfortable;
  • Not use perfumed or antibacterial soaps, feminine deodorant, or douches;
  • Wear comfortable, loose fitting cotton clothing;
  • Take aspirin, acetaminophen (Tylenol and others), or ibuprofen (Advil, Motrin, Nuprin, etc.) if helpful; and
  • Use cool cloths on the affected area if it soothes the pain.

Treatment with medication is effective in shortening the initial outbreak of the infection, lowers the chance that the infection will come back, and makes any later outbreaks less severe.

  • There are similar antiviral drugs available for the treatment of genital herpes infection, These antiviral medications vary in cost and how often they should be taken. All should be taken for 7-10 days. The patient's doctor may extend the course of therapy if ulcers have not healed in 10 days.
  • For preventing later genital herpes outbreaks, people with recurring infections also may benefit from the antiviral medications. Treatment is started when the recurrence first begins and continues for five days.
  • For continuous prevention, a few individuals who have frequent outbreaks (generally over six recurrences per year) can only control the outbreaks  by taking medication every day. Acyclovir, famciclovir, and valacyclovir are all used to treat recurrent disease. This is known as suppressive therapy. Suppressive therapy has been shown to decrease the frequency of genital herpes recurrences by 70%-80% in those who have frequent recurrences, and many individuals taking this treatment report no symptomatic outbreaks.

Herpes Simplex

What Is Herpes Simplex?

There are two strains of herpes simplex viruses:

  • Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and many people develop it in childhood. HSV-1 often causes sores (lesions) inside the mouth, such as cold sores (fever blisters), or infection of the eye (especially the conjunctiva and cornea). It can also lead to infection of the lining of the brain (meningoencephalitis). It is transmitted by contact with infected saliva. By adulthood, 30 - 90% of people will have antibodies to HSV-1. The likelihood of childhood infection is higher among those with lower socioeconomic status.
  • Herpes simplex virus 2 (HSV-2) is usually, but not always, sexually transmitted. Symptoms include genital ulcers or sores. However, some people with HSV-2 have no symptoms. Up to 30% of adults in the U.S. have antibodies against HSV-2. Cross-infection of type 1 and 2 viruses may occur from oral-genital contact. That is, you can get genital herpes on your mouth, and oral herpes on your genital area.

A finger infection, called herpetic whitlow, is another form of HSV infection. It usually affects health care providers who are exposed to saliva during procedures. Sometimes, young children also can get the disease.

HSV can infect a fetus and cause abnormalities. A mother who is infected with HSV may transmit the virus to her newborn during vaginal delivery, especially if the mother has an active infection at the time of delivery. However, 60 - 80% of HSV infections acquired by newborns occur in women who do NOT have symptoms of HSV infection or a history of genital HSV infection.

It's possible for the virus to be transmitted even when there are no symptoms or visible sores. Two-thirds of people with genital HSV infection have recurrences of their symptoms, and one-third have three or more recurrences (outbreaks) per year.

HSV is never eliminated from the body, but stays dormant and can reactivate, causing symptoms.

What Causes Herpes Simplex?

When you think of having an infection you usually assume that you were recently exposed to the germ that has caused your problem. However, with cold sores that is not the case.

Cold sores are not a sign of a recently acquired herpes simplex infection, but instead a reactivation of herpes virus particles already living in your body. Cold sores occur when latent herpes simplex virus particles, which have been lying dormant ("asleep"), become reactivated.

Treatments

Some cases are mild and may not need treatment.

People who have severe or prolonged outbreaks (especially if it is the first episode), people with immune system problems, or those with frequent recurrences will benefit from antiviral medications such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

People who have frequent or severe recurrences of oral or genital herpes may choose to continue taking antiviral medications to reduce the frequency and severity of recurrences.

Oral Herpes

Oral herpes is an infection caused by the herpes simplex virus. The virus causes painful sores on your lips, gums, tongue, roof of your mouth, and inside your cheeks. It also can cause symptoms such as fever and muscle aches.

What Causes Oral Herpes?

Herpes simplex is a DNA virus that causes sores in and around your mouth. Two herpes subtypes may cause these sores.

  • Herpes simplex virus, type 1 or herpes-1, which causes 80% of cases of oral herpes infections
  • Herpes simplex virus, type 2 or herpes-2, which causes the rest

Treatments

Treatment includes medication for fever and drinking plenty of fluids.

  • A topical anesthetic such as viscous lidocaine (Dilocaine, Nervocaine, Xylocaine, Zilactin-L) may be prescribed to relieve pain.
  • Oral or IV medication does exist for herpes but is not recommended for people with a normal immune system. It is used only for people with weakened immune systems, infants younger than 6 weeks, or people with severe disease.
  • Some people may require hospital admission.
  • Those with severe local infection
  • People whose infection has spread to other organ systems
  • People with weakened immune systems
  • Dehydrated individuals who need IV hydration
  • Infants younger than 6 weeks

Next Steps: Follow-up

  • Drink plenty of fluids.
  • Use pain medications as instructed by the doctor.
  • Use medications to control fever.
  • Watch for signs and symptoms of dehydration.
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