Sexually Transmitted Diseases (STDs In Women) (cont.)
Genital Herpes
What is genital herpes?
Genital herpes, also commonly called "herpes," is a
viral infection by the herpes simplex virus (HSV) that is transmitted
through intimate contact with the mucous-covered linings of the mouth or the
vagina or the genital skin. The virus enters the linings or skin through
microscopic tears. Once inside, the virus travels to the nerve roots near the
spinal cord and settles there permanently.
When an infected person has a herpes outbreak, the virus travels down the
nerve fibers to the site of the original infection. When it reaches the skin,
the typical redness and blisters occur. After the initial outbreak, subsequent
outbreaks tend to be sporadic. They may occur weekly or even years apart.
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. The outbreak of herpes is closely related to the functioning of the
immune system. Women who have suppressed immune systems, because of stress,
infection, or medications, have more frequent and longer-lasting outbreaks.
It is estimated 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. It is believed that 60% of sexually active adults
carry the herpes virus. Part of the reason for the continued high infection rate
is that most women infected with the herpes virus do not know that they are
infected because they have few or no symptoms. In many women, there are
"atypical" outbreaks where the only symptom may be mild
itching or minimal
discomfort. Moreover, the longer the woman has had the virus, the fewer the
symptoms they have with their outbreaks. Finally, the virus can shed from the
cervix into the vagina in women who are not experiencing any symptoms.
Symptoms of genital herpes
Once exposed to the virus, there is an incubation period that generally lasts 3 to 7 days before a lesion develops. During this time, there are no symptoms and the virus cannot be transmitted to others. An outbreak usually begins within two weeks of initial infection and manifests as an itching or tingling sensation followed by redness of the skin. Finally, a blister forms. The blisters and subsequent ulcers that form when the blisters break, are usually very painful to touch and may last from 7 days to 2 weeks. The infection is definitely contagious from the time of itching to the time of complete healing of the ulcer, usually within 2-4 weeks. However, as noted above, infected individuals can also transmit the virus to their sex partners in the absence of a recognized outbreak.
Diagnosis of genital herpes
Genital herpes is suspected when multiple painful blisters occur in a sexually exposed area. During the initial outbreak, fluid from the blisters may be sent to the laboratory to try and culture the virus, but cultures only return a positive result in about 50% of those infected In other words, a negative test result from a blister is not as helpful as a positive test result, because the test may be a false-negative test. However, if a sample of a fluid-filled blister (in the early stage before it dries up and crusts) tests positive for herpes, the test result is very reliable. Cultures taken during an initial outbreak of the condition are more likely to be positive for the presence of HSV than cultures from subsequent outbreaks.
There are also blood tests that can detect antibodies to the herpes viruses that can be useful in some situations. These tests are specific for HSV-1 or HSV-2 and are able to demonstrate that a person has been infected at some point in time with the virus, and they may be useful in identifying infection that does not produce characteristic symptoms. However, because false-positive results can occur and because the test results are not always clear-cut, they are not recommended for routine use in screening low-risk populations for HSV infection.
Other diagnostic tests such as polymerase chain reaction (PCR) to identify the genetic material of the virus and rapid fluorescent antibody screening tests are used to identify HSV in some laboratories.
Treatment of genital herpes
Although there is no known cure for herpes, there are
treatments for the outbreaks. There are oral medications, such as acyclovir
(Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex) that prevent the
virus from multiplying and even shorten the length of the eruption. 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. It
is important to remember that there is still 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
six outbreaks in a given year. Acyclovir (Zovirax), famciclovir Famvir), and valacyclovir
(Valtrex) may all be given as suppressive therapies.
Herpes can be spread from one part of the body to another during an outbreak.
- Therefore, it is important not to touch the eyes or mouth after touching the
blisters or ulcers.
- Thorough hand washing is a must during outbreaks.
- Clothing
that comes in contact with ulcers should not be shared with others.
- Couples that
want to minimize the risk of transmission should always use condoms if a partner
is infected. Unfortunately, even when an infected partner isn't currently having
an outbreak, herpes can be spread.
- Couples may also want to consider avoiding
all sexual contact, including kissing, during an outbreak of herpes.
- Since an
active genital herpes outbreak (with blisters) during
labor and delivery can be
harmful to the infant, pregnant women who suspect that they have genital herpes
should tell their doctor. Women who have herpes and are
pregnant can have a
vaginal delivery as long as they are not experiencing symptoms or actually
having an outbreak while in labor.
Next: Human Papillomaviruses (HPVs) and Genital Warts »
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