Sexually Transmitted Diseases (STDs In Men) (cont.)
Genital Herpes
What is genital herpes and how is it spread?
Genital herpes is a viral infection that causes clear blisters that overlie
ulcers on the skin or mucosa (lining of the
body's openings) of sexually exposed areas. Two types of herpes viruses are associated with genital lesions; herpes
simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). HSV-1 more often
causes blisters of the mouth area while HSV-2 more often causes genital sores or
lesions in the area around the anus (perianal region).
Most people infected with HSV-2 have not been diagnosed as being infected. If
symptoms occur, they appear approximately 3 to 7 days after an initial exposure
to herpes. Many men experience mild symptoms, which resolve spontaneously.
Others can develop severe bouts of painful blisters on the penis that can be
accompanied by fever and headache.
Once a herpes infection occurs, it is life-long and can be characterized by
recurrent sporadic outbreaks. The outbreaks occur because the dormant HSV is
activated. Outbreaks occur at different rates in different individuals. The
recurrences can be associated with stress or other infections. They also occur
with increased frequency in those who have weakened immune systems, such as with
HIV infection. These outbreaks usually are characterized by mildly to moderately
painful clusters of blisters over the infected area. The recurrences usually
resolve spontaneously, with the blisters disappearing in about 5 days. HSV in
HIV-infected individuals, however, can cause more severe disease, which often causes ulcers rather than blisters
and persists for a longer time.
Estimates are that as many as 50 million persons in the United States are
infected with genital HSV. Genital herpes is spread only by direct person to
person contact. Again, most infected people have not been diagnosed. Most
genital herpes is passed on by people who do not have active signs of disease at
the time of transmission.
How is herpes diagnosed?
The suspicion for genital herpes is usually based upon
the appearance of multiple, painful clusters of small blisters over the penis or
anal area. The definitive diagnosis is based on a culture of the virus. The
culture is done by opening a blister, swabbing the base of the ulcer, and
sending the swabbed material to the laboratory for culture.
Blood tests that detect antibodies to the HSV reveal
whether someone is infected with herpes. These antibodies are proteins that are
produced by the body in an immunological (defensive) response specifically
targeted against this virus. The antibodies, however, do not indicate whether
the person's current lesions are actually due to the herpes or another disease.
The antibody test,
therefore, is of minimal value in diagnosing genital herpes.
What should persons infected with genital herpes know?
Patients who are newly diagnosed with genital herpes should be aware that
- there is no cure for the infection,
- recurrent episodes can occur, and
- even when there are no obvious lesions, HSV can be spread to others.
Affected individuals should notify their sex partners
that they are infected with HSV. They should avoid sexual activity not only when
the blisters are present, but also when a pre-outbreak tingling, which sometimes
is felt over the involved skin, occurs. Since HSV can be spread even during
periods when there are no symptoms, condoms or other latex barriers should be
used routinely during sexual contact with an infected person. This should be
done even if the condoms are not needed at that time to prevent other STDs or to
avoid pregnancy. Also, women with genital herpes should be aware of the
possibility of that HSV can be spread to a newborn if the mother has an outbreak
at the time of delivery. Finally, people with HSV infection should understand
the clear, but limited role, of antiviral medications for the initial outbreak
and for subsequent outbreaks and for suppressive therapy to prevent recurrences in patients with
frequent outbreaks.
How is genital herpes treated?
Several antiviral drugs have been used to treat HSV
infection, including acyclovir, famciclovir, and valacyclovir. Although topical
(applied directly on the lesions) agents exist, they are generally less
effective than other medications and are not routinely used. Medication that is taken by mouth, or in
severe cases intravenously, is more effective. Patients need to understand,
however, that there is no cure for genital herpes and that these treatments only
reduce the severity and duration of outbreaks.
Since the initial infection with HSV tends to be the
most severe episode, an antiviral medication usually is warranted. These
medications can significantly reduce pain and decrease the length of time until the sores heal, but treatment
of the first infection does not appear to reduce the frequency of recurrent
episodes.
In contrast to a new outbreak of genital herpes,
recurrent herpes episodes tend to be mild, and the benefit of antiviral
medications is only derived if therapy is started immediately prior to the
outbreak or within the first 24 hours of the outbreak. Thus, the antiviral drug
must be provided for the patient in advance. The patient is instructed to begin
treatment as soon as the familiar pre-outbreak "tingling" sensation occurs or at the very onset of blister
formation.
Finally, suppressive therapy to prevent frequent recurrences may be indicated
for those with more than 6 outbreaks in a given year.
The treatment options for HSV include:
|
First Episode
(Treat 7-10 days) |
Recurrent Infection
(Treat 3-5 days) |
Suppressive
Therapy |
| acyclovir (Zovirax)
|
400mg three
times/day
or
200mg five times/day |
400mg three
times/day
or
800mg three/day for 2 days |
400mg
twice/day |
famciclovir
(Famvir) |
250mg three
times/day |
125mg
twice/day |
250mg
twice/day |
valacyclovir
(Valtrex) |
1000mg twice/day |
500mg
twice/day |
500mg
once/day (may be given twice daily)
or
1000 mg once/day in persons with 10 or more outbreaks/year) |
What should a person do if exposed to someone with genital herpes?
People who have been exposed to someone with genital
herpes should obtain counseling about herpes symptoms, the nature of the outbreaks, and how to
prevent acquiring or transmitting herpes in the future. If the exposed person
experiences an outbreak of herpes, he or she should be further evaluated.
Next: Lymphogranuloma Venereum (LGV) »
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