Tuesday, July 22, 2014

Definition

Studies show that genital herpes simplex virus is common. In the United States, one out of five of the total adolescent and adult population are infected with herpes simplex virus.

There are two types of herpes simplex viruses (HSV). HSV type 2 is the one that most commonly causes genital herpes. You can get HSV type 2 during sexual contact with someone who has a genital HSV-2 infection. The infection causes painful sores on the genitals in both men and women. HSV type 1 is the herpes virus that is usually responsible for cold sores of the mouth, the so-called "fever blisters." You get HSV-1 by coming into contact with the saliva of an infected person.

However, HSV type 1 can cause genital herpes, usually caused by oral-genital sexual contact with a person who has the oral HSV-1 infection, and HSV type 2 can cause cold sores.

Description

Herpes can be treated but not cured. Symptoms appear briefly and then disappear; the disease lies dormant in nerve cells, but it may be reactivated by stress or illness. It is believed to be more contagious during active periods when blisters are present, however, it can be transmitted person-to-person without active lesions.

Persons taking drugs that suppress the body's immune system (for example, cancer or organ transplant patients) are at a higher risk of contracting herpes because their bodies are in a weakened state. There is also some evidence that links genital herpes with a higher rate of cancer of the cervix in women.

There are some serious complications of herpes simplex:

Eye infections - the herpes virus may infect the eye and lead to a condition called herpes keratitis. The inflammation results in the feeling that there is something in the eye, pain, sensitivity to light and discharge. Drugs are available that prevent severe scarring of the cornea and in eliminating infection.

Infections in babies - a pregnant woman who has genital herpes at the time of delivery can transmit the virus to her baby as it passes through the birth canal and touches the affected area. The baby can die or suffer severe damage, particularly mental retardation. Women who know that they have had genital herpes or think they might have it during pregnancy should tell their physician so preventive measures can be taken.

A Cesarian section is indicated for some patients. It is estimated that only half of all infants delivered through an infected vagina acquire the disease, but the ones that do are at risk for having a severe infection.

The newborn also is infected by exposure to the virus from non-genital lesions. If the mother or a person working in the nursery has active blisters on the lips or hands, the baby can become infected. Family members and friends with active herpes simplex virus should not handle a newborn.

Note: Pregnant women should avoid sexual contact with a partner with active genital herpes, especially in the later stages of pregnancy. The use of condoms can be suggested for those who will not abstain. There is no evidence to suggest that infection of an infant with herpes simplex virus (HSV type I) carries a different risk than infection with genital herpes HSV type II).

Symptoms

Herpes symptoms can vary. Many infected individuals have few, if any, noticeable symptoms. In people who do have symptoms, the symptoms start 2 to 20 days after the person was exposed to someone with HSV infection. Symptoms may last for several weeks.

The first episode of herpes is usually worse than outbreaks that come later. The predominant symptom of herpes is the outbreak of painful, itching blisters filled with fluid on and around the external sexual organs or, for oral herpes, on or very near the lip. Females may have a vaginal discharge. Symptoms vaguely similar to those of flu may accompany these outbreaks, including fever, headache, muscle aches and fatigue. There may be painful urination, and swollen and tender lymph glands in the groin.

Usually the blisters will disappear without treatment in two to 10 days, but the virus will remain in the body, lying dormant among clusters of nerve cells until another outbreak is triggered. Factors that can trigger an outbreak include stress, illness such as a cold, fever, fatigue, sunburn, menstruation or sexual intercourse.

Many patients are able to anticipate an outbreak when they notice a warning sign (a tingling sensation, called a prodrome) of the approaching illness. It is when they feel signs that an outbreak is about to start that they are particularly contagious, even though the skin still appears normal

Most people with genital herpes have five to eight outbreaks per year, but not everyone has recurrent symptoms. As time goes on, the number of outbreaks usually decreases. Oral herpes can recur as often as monthly or only one or two times each year.

Sores typically come back near the site of the first infection. Usually, as the outbreaks recur, there are fewer sores and they heal faster and are less painful.

Treatment

Unlike other sexually transmitted diseases, herpes cannot be cured because medication that will attack the virus while it lies dormant in the nerve cells will also damage the nerve cells. However, there is treatment available for acute outbreaks that involves the use of anti-viral drugs such as Acyclovir, Valaclovir or Famcyclovir.

Acyclovir has been found to reduce the reproduction of the virus in initial outbreaks, thus possibly lessening the number of subsequent outbreaks. To be effective, therapy must be started immediately after the first sores appear. Every sexual partner of the infected person needs to be examined, and if necessary, treated.

Famcyclovir has similar effects and may work to prevent a herpes infection from establishing itself if taken soon enough in the course of the illness. Valaclovir has similar effects.

Long-term drug therapy ('suppressive treatment') may be helpful for individuals who suffer frequent recurrent outbreaks. Suppressive treatment will reduce outbreaks by 85 percent and reduces viral shedding by more than 90 percent.

Topical antibiotic ointments also may be applied to prevent secondary bacterial infections.

During an outbreak of genital herpes, a number of measures can be taken to make the patient more comfortable:

  • Wear loose clothing
  • Avoid excessive heat or sunlight
  • Keep the sore area clean and dry
  • Place cool or lukewarm cloths on the sore area for short periods of time
  • Do not use perfumed soaps, sprays, feminine deodorants, or douches
  • Take aspirin, acetaminophen or ibuprofen for the pain
  • Avoid touching sores
  • Wash hands if you do touch the sores

Questions

What type of treatment will you recommend to decrease the symptoms or the length of the active period?

Will you be prescribing any medication? What are the side effects?

Can laser therapy be used?

How is laser therapy performed?

How effective is this therapy?

Prevention

Because the chances of contracting this disease increase with the number of sexual partners a person has, limiting the number of partners is the first step toward prevention.

To keep herpes from spreading, intimate contact should be avoided when sores are on the body. Itching, burning or tingling may occur just before the sores develop. Sexual intercourse should be avoided during this time.

Herpes can even be spread when there are no sores or symptoms. To minimize the risk of spreading herpes, latex condoms should be used during all sexual contact. Spermicidal foams and jellies may offer added protection although the evidence on this is controversial.

The herpes virus can also be spread by touching the sores and then touching another part of the body. If you touch the sores, wash your hands with soap and water as soon as possible. Also, do not share towels or clothing with anyone.

Babies can be infected with the herpes virus. If pregnant, you should tell your doctor if you have ever been exposed to anyone with herpes, even if you have never had any symptoms. Your doctor can take special precautions at the time of delivery to protect the baby from getting infected with herpes.