Herpes

What is Genital Herpes?

Genital herpes is an incurable viral infection that is characterized by painful sores on the genitals.

Genital herpes can only be contracted through direct sexual contact, including genital-to-genital, mouth-to-genital, or hand-to-genital contact with an infected partner. Individuals cannot contract the virus through kissing. Occasionally, oral-genital contact can spread oral herpes to the genitals (and vice versa). Individuals with active herpes lesions on or around their mouths or on their genitals should only engage in oral sex if they use a condom or place a small piece of latex, called a dental dam, over the vagina or anus.

The chance of a pregnant woman passing herpes to her baby is highest if the first infection occurs near the time of delivery. The virus can be transmitted to the fetus through the placenta during pregnancy or during vaginal childbirth. First-time infection during pregnancy leads to an increased risk of miscarriage, decreased fetal growth, and preterm labor. About 30-50% of infants who are born vaginally to a mother with first-time infection become infected with the herpes virus. Of babies born to women experiencing recurrent outbreaks at the time of birth, one to four percent become infected with the herpes-simplex virus.

After an initial or primary infection, herpes viruses establish a period called latency, during which the virus is present in the cell bodies of nerves that attach to the area of the original viral outbreak (e.g. genitals, mouth, and lips). At some point, this latency ends and the virus can become active again. While active, the virus begins to multiply (called shedding) and becomes transmittable again. This shedding may or may not be accompanied by symptoms. During reactivation, the virus multiplies in the nerve cell and is transported outwardly via the nerve to the skin. The ability of herpes virus to become latent and reactive explains the long-term, recurring nature of a herpes infection.

Recurrence of the viral symptoms is usually milder than the original infection. Recurrence may be triggered by menstruation, sun exposure, illnesses that cause fevers, stress, immune system imbalances, and other unknown causes. However, not all patients experience a second outbreak.

Genital Herpes Symptoms

Genital herpes typically causes painful, watery blisters to develop on the skin, mucous membranes (e.g. the mouth or lips), or genitals. The location of these blisters depends on where contact was made during transmission. Lesions heal with a crust-forming scab, the hallmark of herpes. Many individuals with recurrent disease develop pain in the area of the infection even before any blisters or ulcers can be seen. This pain is due to irritation and inflammation of the nerves leading to the infected area of skin. These are signs that an outbreak is about to start. An individual is particularly contagious during this period, even though the skin still appears normal.

Genital Herpes diagnosis

A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. The samples are sent to a laboratory where they are analyzed. It takes between one and 14 days to detect the virus in the preparation made from the specimen. This test is useful, but it is sometimes difficult to detect the virus in the sample.

An immunofluorescence assay is a technique used to identify antibodies to the HHV-1 and 2. These antibodies are proteins that help the body fight against HHV-1 and 2. If the specific antibodies are present, the patient was in contact with herpes virus in his or her life and will need to discuss the clinical significance of the result with a medical expert.

A polymerase chain reaction (PCR) test may also be performed to determine whether the virus itself is present in the patient's blood. A sample of the patient's blood is taken and sent to a laboratory. If the virus' genetic makeup (DNA) is present, a positive diagnosis is made. The virus can even be detected during the latent stages of the infection.

Genital Herpes Treatment

Although there is no cure for genital herpes, medications are available to minimize the number of outbreaks, reduce the likelihood of viral shedding, and decrease the likelihood of transmission.

There are three antiviral medications that the U.S. Food and Drug Administration (FDA) has approved for the treatment of genital herpes. Approved antiviral drugs include acyclovir (Zovirax®), valacyclovir (Valtrex®), and famciclovir (Famvir®). Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.

With episodic therapy, the patient begins taking the medication at the first sign of an outbreak. The medication is then taken for several days to hasten the recovery or healing or to prevent a full outbreak from fully occurring. All three of the approved medications help shorten the amount of time that a person may experience symptoms of herpes. However, results may vary from person to person.

Suppressive therapy is used in individuals with recurrent genital herpes who want to prevent outbreaks. Patients who have six or more outbreaks per year may take antiviral medications on a regular basis, before symptoms appear. For these individuals, studies have reported that suppressive therapy may reduce the number of outbreaks by at least 75% while the medication is being taken. Suppressive therapy may completely prevent outbreaks in some patients. Suppressive therapy may need to be taken for the rest of the patient's life.

Side effects of antiviral medicines include stomach upset, loss of appetite, nausea, vomiting, diarrhea, headache, dizziness, and/or weakness.

Genital Herpes Resources

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