Genital Herpes

Genital herpes is a highly contagious sexually transmitted infection (STI) caused by the herpes simplex virus HSV. There are two types of herpes simplex virus which are closely related but differ in the means of transmission: herpes simplex virus 1 is transmitted chiefly by contact with infected saliva and causes cold sores around the mouth, while herpes simplex virus 2 is transmitted sexually or from a mother's genital tract infection to her newborn and causes painful blisters on the thighs, genitals, or rectum that break open and turn into sores.

Both types of viruses can be transmitted very easily through direct contact. A person can get the cold sores of HSV1 by kissing or sharing eating utensils with an infected person. A person can get genital herpes or HSV2 by having intimate contact with an infected person. The virus can enter your body through a break in your skin or through the skin of your mouth, penis or vagina, urinary tract opening, cervix or anus. Herpes is most easily spread when blisters or sores can be seen on the infected person. But it can be spread at any time, even when there aren't any symptoms. Herpes can also be spread from one place on your body to another, for example from your genitals to your fingers, then to your eyes or to other parts of your body. A mother who has genital herpes can pass the infection on to her newborn if she delivers the baby vaginally.

In the United States, HSV is ubiquitous. HSV1 is usually acquired in childhood by contact with oral secretions containing the virus. HSV-2 becomes an issue when the individual becomes sexually mature. Approximately 80% of adults have antibodies to HSV-1, whereas antibodies to HSV-2 are found in approximately 20% of the population. The incidence of genital herpes has been estimated to be 500,000-1,000,000 cases per year with a prevalence of 40-60 million affected individuals.

Internationally, more than one third the world's population has recurrent clinical HSV infections. Reportedly, 13-40% of the world's population is seropositive for HSV-2 and 56-85% is seropositive for HSV-1, varying by country. Also, men are 20% more likely to develop recurrences of HSV-2 than are women. 

SIGNS AND SYMPTOMS 

HSV2 infection occurs in two stages:

The primary stage appears 2-20 days after exposure to the virus. Many primary infections are asymptomatic. In this case there are no visible sores but it IS contagious. It is now estimated that over 80% of all genital herpes is transmitted when there are no lesions and no symptoms. When they are symptomatic, they are usually more severe than recurrent infections.  Women's symptoms are more severe, and women have a higher rate of complications than men. Symptoms include fever, headache, malaise, and myalgia (prominent in the first 3-4 days), pain, itching, dysuria, vaginal and urethral discharge, and tender lymphadenopathy. In women, herpetic vesicles appear on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus (the vaginal opening). In moist areas, the vesicles rupture, leaving exquisitely tender ulcers. In men, herpetic vesicles appear in the glans penis, the prepuce, the shaft of the penis, and sometimes on the scrotum, thighs, and buttocks. In dry areas, the lesions progress to pustules (small blisterlike elevations of epidermis from which spores emerge) and then crust. Persons who engage in anal intercourse may develop herpetic vesicles on perineum or rectum, which can lead to herpetic proctitis. Primary lesions persist from 4-15 days until crusting and reepithelialization occur. New lesions can occur during the course of the illness in 75% of patients, usually forming in 4-10 days.

Recurrent genital herpes occurs after a period of latency, which can last several months. Recurrent outbreaks are milder and and often preceded by a prodrome of pain, itching, tingling, burning, or paresthesia (a sensation of burning, prickling, tingling, or creeping on the skin) that can last from 2 hours to 2 days. In women, the vesicles are found on the labia majora, labia minora, or perineum. The lesions are often very painful. The lesions heal in 8-10 days and viral shedding lasts an average 5 days. The symptoms are more severe in women than men. In men, recurrent genital herpes presents as 1 or more patches of grouped vesicles on the shaft of the penis, prepuce, or glans. Pain is mild, and lesions heal in 7-10 days. The frequency and severity of recurrences decrease with time.  

TREATMENT 

While there are no known cures for herpes, there are several safe medications to reduce outbreaks. Medical treatment of HSV revolves around specific antiviral treatment: Acyclovir (Zovirax), Valacyclovir (Valtrex), Famciclovir (Famvir).  

COMPLICATIONS 

Left untreated, genital herpes may have serious consequences. The most common complication of HSV infections is bacterial superinfection. In women with primary HSV-2 infection, aseptic meningitis is also common. The most significant complications include visceral infections and central nervous system complications.

Visceral infections (infections of the visceral organs), usually result from viremia (the presence of virus in the bloodstream), and multiple organ involvement is common. This may occur during otherwise asymptomatic primary infections. In most cases of disseminated herpes, the lesions are confined to the skin; however, fatal visceral dissemination can occur with or without vesicular skin lesions. The most common complication is HSV hepatitis. Disseminated herpes can also lead to herpetic esophagitis, adrenal necrosis, interstitial HSV pneumonitis, HSV cystitis, HSV arthritis, HSV meningitis, and HSV encephalitis.

Central nervous system complications include: aseptic meningitis which is a condition in which the layers lining of the brain, or meninges, become inflamed and a bacterial or viral source cannot be detected, ganglionitis (inflammation of a ganglion), myelitis (an inflammatory disease of the spinal cord), and herpes simplex encephalitis (a viral infection of the brain). 

PREVENTION 

There is no vaccine that prevents this contagious disease, but other methods of prevention before and during an outbreak are important. If tingling, burning, itching, or tenderness occurs in an area of the body where there is a herpes infection, the area should be kept away from other people. Condoms can help prevent transmission of genital herpes between sexual partners and should always be used. However, they will not protect against the virus that may be living on nearby genital skin that is not covered by the condom.

If you experience HSV symptoms it is important to seek medical care.

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