Genital Herpes is a chronic viral infection affecting 500,000 people every year in the United States. Another name for genital herpes is herpes simplex type 2. It is usually transmitted from person to person through sexual activity. It is more common in females than males. Herpes tends to be a recurring illness.
Genital herpes is caused by a virus called herpes simplex. There are two types of herpes, herpes simplex type I and herpes simplex type II. Type II (genital herpes) is responsible for 90% of the cases and herpes type I causes about 10%. The time from exposure to the onset of symptoms is about three to eight days, although it can be a month or more. The risk of a susceptible female contracting the infection from an infected male over the period of a year is about 20%. The risk of a susceptible male contracting the infection from an infected female over the period of a year is about 5%. This means that a couple can have regular sexual relations over a period of a year and the disease is only transmitted part of the time. After the initial infection, the virus stays in the body. It remains in the nerve cells and will come out from time to time in certain individuals. The virus is frequently transmitted even when the infected individual is not having any symptoms of the infection at the time of intercourse. In fact, 60-70 percent of patients that have herpes do not recognize that they have the infection. This makes preventing the infection particularly difficult since there are no warning signs that a person may be shedding the virus. This asymptomatic (without symptoms) period with shedding of the infectious virus is most prevalent during the first three months after the initial infection. This means the person has no symptoms, but is releasing the virus from his or her skin and can, therefore, spread it to a sexual partner. After this three-month period, there is only a one percent chance of asymptomatic shedding of the virus.
The first time a person is infected with herpes, he or she may become much more ill than with subsequent infections. Many times people may only have one infection without any recurrences. Usually, they will have recurrences that occur three to four times a year. If the initial episode is severe, the patient is less likely to have a recurrence. The less severe the initial episode, the more likely a person is to have frequent recurrences.
The symptoms are listed below:
Multiple painful sores which are usually on the penis of the male or
the vagina of the female. The sores may occur on any surrounding area.
Herpes can last up to three weeks. The sores are small, painful water blisters surrounded by redness and swelling. The subsequent infections are characterized by a tingling discomfort in the same area as the initial infection. This is followed by the formation of a patch of water blisters as noted previously. The subsequent infections are not usually as severe and are not associated with the initial symptoms such as fever, headache and malaise. The sores may only last for seven to ten days. With time and treatment, there is a general tendency for the recurrences to decrease in severity and frequency.
Occasionally, the infections can cause the bladder stem to close up and the person requires a catheter to urinate. Aseptic meningitis may occur in up to 30% of the cases. Another complication that can occur from a herpes infection is transmission to an infant from an infected mother. This is more likely to occur if the mother has her primary infection during labor. The mother may need to have a C-section in order to prevent transmission to the baby.
Conditions that may precipitate a recurrence are:
Excessive sun exposure
The diagnosis of herpes is usually made by the patient's history and clinical exam. Herpes usually has a characteristic appearance. A viral culture may be obtained. Blood tests for herpes are usually not necessary and they are not very helpful. A PAP smear will occasionally reveal herpes simplex.
Analgesics are very helpful during the painful outbreak. Cool compresses may also help relieve the discomfort. It is important to avoid intercourse during an active outbreak. There are several anti-viral agents that markedly shorten the course of herpes infections. Acyclovir has been used for years to treat herpes. The usual dose is 200 milligrams five times a day for five days. This medication can also be taken as 400 milligrams three times a day or 800 milligrams twice a day for five days. For the initial infection the medication may need to be continued for more than five days. If a person has over four or five recurrences in a year, then he or she should consider taking acyclovir prophylactically. This is accomplished by taking 400 milligrams of acyclovir two times a day on a regular basis. This treatment appears to be safe and effective for at least six years. In my experience, people rarely have an outbreak of herpes when they take the acyclovir prophylactically. There are several new medications that can also be used to treat herpes infections. Famvir is taken twice a day for five days. Condoms can help prevent the spread of herpes. Information on herpes can be obtained by calling the Herpes Resource Center at 919-361-8488.
Wiedermann BL, et al. Genital Herpes. Griffith' 5 Minute Clinical Consult.
2004, Electronic version 4.0.139.
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