Genital herpes

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If there's one thing most people in the United States share, it's the herpes simplex virus (HSV). Four out of five of us harbor HSV type 1, which is usually responsible for cold sores; one in six has HSV type 2--the principal cause of genital herpes. Both strains can infect any part of the body.

While cold sores are usually minor medical annoyances, genital herpes can disrupt one's life. Although HSV cannot be eradicated, it doesn't cause long-term damage in healthy adults. Antiviral medications, good hygiene, and a positive attitude can make it easier to live with herpes.

HSV infection
The experience of an HSV infection varies widely from person to person. The first sign is often an itching or burning sensation, perhaps even pain in the buttocks or groin, accompanied by a slight inflammation of the skin or mucous membrane. Within 1-2 days, a cluster of small blisters appears. They break and weep after a few more days, leaving ulcerlike sores that usually crust over and heal in 1-3 weeks. Genital ulcers may occur on the genital region, buttocks, urethra, or bladder. The inflamed lesions may cause a vaginal discharge that mimics symptoms of vaginitis, or cause painful urination.

By the time the sores have healed, the virus has moved deep into the body, following a path along sensory nerve endings to clusters of nerve cells called ganglia. There it lies dormant for an indefinite period. During this, the latent phase, HSV is harmless.

The virus occasionally retraces its steps along the nerve to the surface of the body, where it forms new lesions. Recurrences usually occur in the first year after the primary infection. As a rule, the number and severity of attacks decrease with time.

Scientists are not certain what triggers a recurrence. Many patients report that a variety of factors--surgery, stress, fatigue, changes in diet, menstruation, or vigorous sexual intercourse can precipitate an episode. Again, the factors responsible differ among individuals. Occasionally, a recurrence may come years after a primary attack that was too mild to be noticed.

Herpes is most easily spread when sores are present, both by sexual intercourse and oral/genital sex. However, the virus can also be "shed" during the period immediately before a sore appears. Sexual contact during asymptomatic periods is less likely to result in transmission of the virus than when sores are present. However, since people with herpes are more likely to have sex when they are free of sores, the rate of asymptomatic transmission is still significant. Infants born to women with genital herpes can be infected with HSV when they pass through an infected birth canal. The virus can also be passed to other regions of the body by hand contact, particularly in people who are undergoing chemotherapy or who have AIDS or other conditions that weaken the immune system.

Diagnosis
HSV can often be identified by the sores it produces. Clinicians can make a more positive diagnosis by culturing fluid swabbed from an open lesion, although a "negative" result doesn't always rule out HSV infection. They may want to test for other sexually transmittted diseases (STDs) also.

Treatment
An HSV vaccine that showed great promise in animals ultimately failed the test in humans. Although there is still no immunization against HSV infection, new antiviral drugs can minimize recurrences. Three oral drugs--acyclovir, famciclovir and valacyclovir--are active against primary and recurrent HSV. While they do not cure HSV, they can significantly reduce the symptoms associated with an outbreak, decrease viral shedding, and promote faster healing.

These drugs, which are available only by prescription, are most effective if taken when symptoms first appear. Patients with more than six recurrences a year can take these drugs in low daily doses to suppress the outbreaks. However, because the long-term effects are still unknown, use should be limited to one year. Acyclovir ointment may speed healing, but there is no evidence that it prevents recurrences.

Other measures can also hasten healing of lesions. It is important to keep the infected area dry and clean and to avoid tight-fitting undergarments that can trap moisture.

Living with herpes
Meticulousness is a trait to be cultivated if you have HSV.

Avoid self-infection. Don't touch the affected areas during an outbreak. Wash your hands frequently.
Practice abstinence and safe sex. Abstain from sexual contact until all sores have healed. Intercourse during an active infection not only transmits the virus, it dramatically increases the risk of contracting HIV and other STDs. Condoms and spermicidal foams or jellies containing nonoxynol-9 offer additional protection against viral transmission.
Tell your obstetrician. If you are pregnant, your obstetrician can determine whether a cesarean section is necessary to avoid infecting the baby.
Get regular Pap smears. These can identify HSV infections of the cervix.
Seek emotional support. For many people, the psychological pain is worse than the physical discomforts of HSV infection. Psychotherapy and support groups can be valuable. For a list of support groups and other information, call the American Social Health Association's Herpes Hotline, 1-919-361-8488, Monday through Friday, 9 AM to 7 PM, eastern time.

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