Genital Herpes

Genital herpes is a sexually transmitted disease, or STD.  It is a common viral infection that is most often spread through sexual activity.  Genital herpes is caused by a strain of herpes simplex virus (HSV), which enters your body through small breaks in your skin or mucous membranes. The sores will appear at places where the virus entered the body, usually the genitals, lips, or anus. 

The Basics

Genital herpes is a disease caused by HSV, of which there are two types. Type 1 (HSV-1) usually causes oral herpes, an infection of the lips and mouth. These symptoms are generally known as cold sores or fever blisters. Type 2, or HSV-2, lives in the nerves. When active, it travels to the surface of the infected area, usually the skin or a mucous membrane, and makes copies of itself. This is called "shedding" because these new viruses can, at this time, rub off on another person. Then the virus travels back down the nerve to a ganglion (mass of nerve tissue), usually at the base of the spine, where it lies dormant for a while.

Infection and Your Risk

It is estimated that about 45 million people in the U.S. are infected with the HSV-2 virus, but as many as 90% of those people don't know it.  Women are more likely to have the disease, probably because the virus can infect a woman's genitals more easily than it can a man's. The higher the number of sex partners a person has, the higher the risk that they will be infected, since HSV-2 is most often passed by vaginal, anal and oral sex.  HSV-2 cannot survive long on a non-living surface, so there is no real risk of getting it from a toilet seat or hot tub, for example.

Prevention

Using a condom during sex may protect you or your partner, but only if it covers the area where the virus is shedding. Avoid having sex from the time that the sores appear until a few days after they have gone away.  At this time especially, cleanliness is very important to minimize the risk of passing the virus along.  It's important to know that HSV can be contagious even when no sores are present, since the virus can be present without causing any symptoms.  The only way to know for sure is to be tested.

Symptoms

The most common symptom of genital herpes is a cluster of small fluid-filled blisters that break, forming painful sores that crust and heal over several days.   However, some people get only a rash, or small pimple-like bumps on the skin.  Others have no sores but experience painful urination or, in the case of women, a fluid discharge from the vagina.  When a person is first infected, they may experience flu-like symptoms before the sores appear.  These generally appear 4-7 days after the contact that caused the infection.

The first outbreak of genital herpes is usually the worst, and may last two to four weeks.  After that, there is no normal pattern of symptoms, although in later outbreaks the sores are usually less painful and last for a shorter time.   Outbreaks can range from once a year to every few weeks.  Before an outbreak, a person may experience an itching, tingling, or burning sensation in the affected area, and there may be sharp pains in the pelvis or down the leg.  The rash can appear on the vagina, anus, urethra, vulva, penis, scrotum, even the thighs and buttocks. 

Diagnosis and Treatment

If you have any of these symptoms, tell your health care provider so that you can be tested.   The most accurate way is to take a sample from a sore and look for HSV under a microscope.  Blood tests are also helpful because they can check for the presence of the antibodies that the body produces in response to HSV.  These antibodies are present even when you have no symptoms, so you don’t have to be tested during an outbreak.

There is no cure for genital herpes, but there are drugs available to help manage the symptoms and, in many cases, reduce the length and severity of an outbreak.   These drugs are used in three different ways:

Initial treatment –  If the disease is diagnosed during the initial outbreak, a  healthcare provider will usually prescribe a 7 to 10 day course of antiviral medication to relieve the pain or prevent the outbreak from worsening.   After the first treatment, there are two options for antiviral therapy for the long term.  They are:

1. Intermittent treatment –  A healthcare provider may prescribe an antiviral drug to use only during outbreaks.  The pills are taken for 1 to 5 days once symptoms occur.  This type of therapy can make the symptoms less severe.
2. Suppressive treatment – People who have six or more outbreaks per year are usually candidates for suppressive therapy, which involves taking an antiviral drug daily.  Suppressive therapy can sharply reduce the number of outbreaks.  Some people who take the antiviral drugs daily have no outbreaks at all.  Suppressive therapy can also reduce the risk of transmitting the virus to sexual partners.

Recurrences

Once you have contracted the herpes virus, it doesn’t leave your body.  It resides in nerve cells near your spine until something triggers a new outbreak.  Trigger factors vary from person to person and usually can't be avoided. Some triggers are believed to be:

• Sexual intercourse
• Menstruation
• Emotional or physical stress
• Injury, illness or surgical trauma
• Steroids
• Poor diet

While some of these triggers are out of your control, two very important ones – your diet and your emotional stress level – aren’t.  It’s always a good idea to eat a nutritious, balanced diet, and exercising regularly can help to lower the stress-producing chemicals in your body.
For more information on what you can do to prevent recurrences of genital herpes, go online to http://www.herpesonline.org/articles/living_with_herpes.html

Pregnancy and Genital Herpes

The physician or midwife needs to be informed if a pregnant woman has genital herpes.  Women who are infected with genital herpes for the first time near the time of delivery have a 30 to 50 percent chance of passing the infection on to their babies during a vaginal delivery, whether or not they have symptoms.  This is due to the fact that a newly infected pregnant woman has not yet produced the antibodies that could help protect her baby during delivery. However, only about two percent of pregnant women acquire herpes for the first time during pregnancy, and there are medications that can reduce the possibility of an outbreak.

A pregnant woman who does not have a history of genital herpes should take special precautions to stay infection-free, especially in the last trimester, when risk to the baby is highest.   If her partner has a history of herpes, the healthcare provider may take a blood test to find out whether she is also infected.  If the test is negative, the doctor or midwife may recommend that she avoid intercourse and oral-genital contact in the last trimester.    Sexual intercourse should also be avoided anytime the partner has symptoms or an outbreak, and a condom should always be worn even when symptoms are not present. 

Remember

Genital herpes is a common, easily transmitted virus.  It is a health condition that cannot be cured but can be managed and treated with help from your healthcare provider.
It is also very important that a pregnant woman know whether she has this condition or not so that, if necessary, appropriate steps may be taken to protect her baby.