 One
in five Americans are now infected with genital
herpes, but only a small fraction know that they have
the disease, proving it can spread efficiently and silently.
What
is genital herpes?
Genital
herpes infection usually is acquired by sexual contact with someone
who is infected, but has no visible sores at the time. Herpes simplex
virus (HSV) type 1 most commonly causes fever blisters or cold
sores on the lip, but it can cause genital infections as
well. HSV type 2 most often causes genital sores (lesions), but
it also can infect the mouth.
What
happens?
After
invading the skin or mucous membranes, the virus travels to the
sensory nerves at the end of the spinal cord, where it remains for
life. Periodic recurrences of the infection, caused by reactivation
of the virus may occur in some people. Although researchers don't
know why, some people report that their recurrences are brought
about by illness, stress, menstruation, or exposure to sunlight.
What
are the symptoms?
Symptoms
of a first episode of genital herpes usually appear within a week
of being infected, and can last an average of two to three weeks.
Small red bumps appear at the site of infection, develop into blisters,
and then become painful open sores. The sores may or may not be
visible to the naked eye. Over a period of days, the sores become
crusted and then heal without scarring.
Other
symptoms that may occur with the first episode of genital herpes
can include fever, headache, muscle aches, painful or difficult
urination, vaginal discharge, and swollen nodes in the groin area.
People often blame these symptoms on allergies or bladder or yeast
infections.
A recurrent
attack may be signaled by tingling, itching, or pain and is called
a prodromal phase. When the virus reactivates it travels along the
nerves, to a site near the first outbreak, causing new sores to
erupt. It also can reactivate without causing any visible sores.
How
is it diagnosed?
Laboratory
tests may be needed to diagnose and distinguish herpes from other
infections. The best way to diagnosis herpes is by viral culture,
in which a sore is scraped and the sample is sent to the laboratory
for analysis. The virus is sometimes hard to detect, but this does
not mean that herpes is not present. New blood tests that are available
make it easier to diagnose genital herpes.
| Antiviral
Medications for Genital Herpes |
Acyclovir
(Zovirax) helps patients with first or recurrent episodes
of genital herpes. The oral form of the drug is taken
five times a day and markedly shortens the course of the
first episode, and limits the severity of recurrences,
particularly if taken within 24 hours of onset of symptoms.
People who have very frequent recurrent episodes of the
disease can take oral acyclovir twice daily to suppress
the virus' activity and prevent most recurrences. |
Famciclovir
(Famvir) and valacyclovir
(Valtrex) may also be used to treat recurrent episodes
of genital herpes. Famciclovir also has been approved
for use in suppressing viral activity and preventing recurrences.
These two drugs are taken less frequently than acyclovir,
e.g., three times a day for an episode and once a day
to help stop further recurrences. |
|
How
is it treated?
The
disease has no cure, but is controllable. Antiviral medications
can markedly shorten the course of the first episode. They can also
suppress viral activity and prevent or lessen the severity of most
recurrences. The medicines are not a cure for herpes - the virus
remains in the body for life. Taking the medications on a daily
basis may reduce the risk of passing the virus on to sexual partners.
What
to do
During
an active herpes episode, whether primary or recurrent, it is important
to follow a few simple steps to speed healing and to avoid spreading
the infection to other sites of the body or to other people:
- Keep
the infected area clean and dry to prevent secondary infections
from developing.
- Avoid
touching the sores and if you do touch them, wash your hands after
contact with the sores.
People
with early signs of a prodrome or with visible sores should not
have sexual intercourse until the sores have healed completely (the
scab has fallen off and new skin has formed over the site of the
sore).
During
this time, small amounts of the virus may be shed at or near sites
of the original infection. Herpes sores, by providing a point of
entry, allow easier transmission of HIV. Between outbreaks, using
condoms during sexual intercourse may offer some protection.
A pregnant
woman who develops a first episode of genital herpes can pass the
virus to her baby. The baby's chances of infection depend on whether
the mother is having a recurrent or a first outbreak.
If
it is a first outbreak (especially with HSV type 1) near or at the
time of a delivery, the baby's risk of infection is approximately
one in three. If the outbreak is a recurrence, the baby's risk is
very low (less than one in 30). Because of the danger of infection
to the baby, however, the doctor will perform a cesarean section
if herpes lesions are detected in or near the birth canal during
labor.
About
45 million people wrestle with the emotional and physical ramifications
of having herpes. Genital herpes can be distressing, inconvenient,
and sometimes painful. Concern about transmitting the disease to
others and disruption of sexual relations during active outbreaks
of the sores can affect personal relationships. However, it is possible
to cope with and manage herpes with medical treatment and preventive
measures.
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