Genital Herpes

couple appearing to have an argumentAlternative Names

Herpes – genital; Herpes simplex – genital; Herpesvirus 2; HSV-2

Definition

Genital herpes is a sexually transmitted viral infection affecting the skin
of the genitals.

Causes

Herpes is caused by two viruses:

– Herpes simplex virus type 1 (HSV-1)
– Herpes simplex virus type 2
(HSV-2)

HSV-1, the virus responsible for common cold sores, can be transmitted
through fluids from the mouth. It is responsible for some cases of genital
herpes cases. HSV can spread from the mouth to the genitals during oral sex.

HSV-2 causes most of the genital herpes cases. HSV-2 can be spread through
secretions from the mouth or genitals.

Herpes simplex virus (HSV) is spread from one person to another by
skin-to-skin contact. The virus is shed from visible sores, blisters, or a rash
during outbreaks, but can also be shed from the affected area between outbreaks
of symptoms.

HSV is transmitted to the area of skin with which it comes into contact.
There are also some cases by which other types of contact can spread HSV. For
example, a variant of herpes, known as herpes gladiatorum, can be passed on
during body contact sports, such as wrestling.

Because the virus is transmitted through secretions from the mouth or genital
tissue (mucosa), common sites of infection in men include:

– Anus
– Inner thighs
– Scrotum
– Shaft and head of the penis

Common sites of infection in women include:

– Anus
– Cervix
– Inner thighs
– Labia
– Vagina

The mouth can also be a site of infection in both sexes.

Research suggests that the virus can be transmitted even when there are no
symptoms present, so that a sexual partner without obvious genital herpes sores
can still transmit the illness. In fact, asymptomatic spread may actually
contribute more to the spread of genital herpes than do active sores.

Symptoms

For people with no prior contact with HSV-1 or HSV-2, initial infection
involves both whole body (systemic) and local symptoms.

Generalized symptoms include:

– Decreased appetite
– Fever
– Malaise
– Muscle aches

Local symptoms include repeated eruptions of small, painful blisters filled
with clear, straw-colored fluid on the genitals, around the rectum, or covering
nearby areas of skin. Before these blisters appear, the person may experience
increased skin sensitivity, tingling, burning, itching, or pain at the site
where the blisters will appear.

When the blisters break, they leave shallow ulcers that are very painful.
These ulcers eventually crust over and slowly heal over 7 – 14 days.

Enlarged and tender lymph nodes in the groin may accompany an outbreak. Women
also may develop vaginal discharge and painful urination. Men can develop
painful urination if the lesion is near the opening of the urethra.

Once a person is infected, the virus hides within nerve cells, making it
difficult for the immune system to find and destroy it. Within the nerve cells,
the virus can remain dormant for a long period of time, which is called
“latency.”

The infection can reactivate at any time, at which point painful blisters
again cover the genitals, anus, inner thigh, or mouth. A variety of events can
trigger latent infection to become active, including:

– Fatigue
– Mechanical irritation
– Menstruation
– Stress

Attacks can recur as seldom as once per year, or so often that the symptoms
seem continuous. Recurrent infections in men are generally milder and shorter in
duration than those in women.

Exams and Tests

– Viral culture of blister fluid from lesion is positive for herpes simplex
virus. The herpes simplex virus can grow within 2 – 3 days.
– PCR from the
blister fluid detects small amounts of DNA and can tell whether the herpes virus
is present in the blister.
– Tzanck test of skin lesion may show results
consistent with herpes virus infection. This test involves staining human cells
within the blister fluid with a dye. If the cells from the fluid contain viral
particles, they become visible. However, the test cannot determine which strain
of virus is in the blister.

Recently developed antibody tests can determine whether a person has HSV-1 or
HSV-2. These tests can also tell if a person has ever been exposed to either of
these strains in the past (IgG test) or was just recently exposed to one of them
(IgM test).

Treatment

Genital herpes cannot be cured. However, antiviral treatment can relieve the
symptoms. Medication can quickly relieve the pain and discomfort during an
outbreak, and can shorten healing time. Medications have been shown to speed
healing and relieve symptoms in first attacks more than in recurrent episodes of
genital HSV-1 and HSV-2 infections.

If necessary, patients can use daily suppressive therapy, which may reduce
the frequency of recurrence in patients with frequent genital herpes
outbreaks.

For maximum benefit during recurrences, start therapy as soon as the
tingling, burning, or itching begins, or as soon as you notice blisters.

Possible side effects from herpes medications include:

– Fatigue
– Headache
– Nausea and vomiting
– Rash
– Seizures

– Tremor

Some people need medication through a vein (intravenous) for severe herpes
infections that can involve the brain, eyes, and lungs. These complications
sometimes develop in people with a compromised immune system.

Warm baths may relieve the pain of genital lesions. Gentle cleansing with
soap and water is recommended. If you develop a secondary infection of the skin
lesions by bacteria, you can use a topical or oral antibiotic.

Support Groups

See: Herpes genital – support group

Outlook (Prognosis)

Once you are infected, the virus stays in your body for the rest of your
life. Some people never have another episode, and others have frequent
recurrences. In most recurrences, no obvious trigger is identified. Many people,
however, find that attacks of genital herpes occur with the following
conditions:

– Fatigue
– General illness (from mild illnesses to serious conditions,
such as operations, heart attacks, and pneumonia)
– Immunosuppression due to
AIDS or medication such as chemotherapy or steroids
– Menstruation

Physical or emotional stress
– Trauma to the affected area, including sexual
activity

In people with a normal immune system, genital herpes remains a localized and
bothersome infection, but is rarely life-threatening.

Possible Complications

Various complications are associated with herpes infection. The herpes virus
is of special significance to women because research has found that it can cause
cancer of the cervix. The risk increases when HSV is present in combination with
human papilloma virus (HPV), the virus responsible for genital warts
(condyloma).

For pregnant women, HSV-1 or HSV-2 on the outside of the genitals or in the
birth canal is a threat to

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