Genital Herpes
Herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus (HSV).
Genital herpes infection is very common and on the increase in the United States. Nationwide 45 million people aged 12 and older (1 out of 5 of the total adolescent and adult population) are infected with HSV-2.
It is more common in women (1 out of 4) than in men (1 out of 5) possibly because male to female transmission is more efficient than female to male transmission.
HSV-2 infection is also more common in areas of high socio-economic disadvantage, facing fundamental issues of health such as:
access to quality health care
poverty
living in communities with a high prevalence of STDs
illicit drug use
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The Herpes Virus
HSV-type 1
causes fever blisters on the mouth or face (oral herpes)
HSV-type 2
typically affects the genital area (genital herpes)
Both viral types can:
be inactive or 'silent' causing no symptoms
cause either genital or oral infections
cause 'outbreaks' of blisters and ulcers
People can remain infected for life after the first initial episode
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Transmission
Herpes is spread by direct contact including:
Sexual contact
Anal sex
Oral sex
Vaginal sex
as well as
Kissing
Skin-to-skin contact which transmits HSV-1 and HSV-2
Genital herpes
Can be transmitted with or without the presence of sores or other symptoms
Is often transmitted by people who do not realize infection can be passed on even when there are no symptoms
Is often transmitted by people unaware they are infected
Statistics
An estimated 40 million people have genital herpes which is a chronic viral infection
About 500,000 new people get symptomatic herpes each year
There are even more people without symptoms
Genital herpes infection
has increased 30% in the U.S.
has increased most dramatically among young white teens (12-19 years old)
among whites is 5 times higher than 20 years ago
is twice as likely to infect 20-29 year old adults
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Questions
How serious is Herpes?
Mild symptoms can be experienced with HSV-2, but often no apparent symptoms are present.
HSV-2 may cause recurrent painful genital ulcers and can be severe in people with suppressed immune systems. Severe genital herpes frequently causes psychological and emotional stress.
If a woman with HSV-2 is pregnant, potentially fatal infections in infants can occur. A cesarean -section delivery is usually carried out if a woman has active genital herpes at time of giving birth.
People infected with herpes may be more susceptible to HIV infection, and HIV-infected individuals may be more infectious.
How do you know if you are infected with genital herpes?
Many people with HSV-2 are sometimes not aware that they are infected.
Some people infected with HSV-2 do not have lesions or may suffer only very mild, almost unnoticeable, symptoms which are sometimes mistaken for insect bites or a rash.
Symptoms of the primary episode can be quite pronounced. The primary episode usually occurs within two weeks after the virus is transmitted and lesions usually heal within 2-4 weeks of outbreak.
Other symptoms may include a second crop of lesions, or flu-like symptoms including:
fever
swollen glands
A primary episode of genital herpes can cause several symptomatic recurrences a year (average 4 or 5). Most recurrences occur more often within the first year following the primary episode.
Herpes simplex, a recurrent viral infection, caused by Herpes Virus hominis (HVH), is a widespread infectious agent, which is very hard to control. As well there are latent herpes associated infections.
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Symptoms
Symptoms vary, but often most people have no noticeable symptoms.
Early symptoms may include:
burning sensation in the genitals
flu-like symptoms
lower back pain
pain when urinating
Small red bumps may appear in the genital area after initial symptoms, which later develop into painful blisters.
The blisters usually:
crust over
form a scab
heal
GENITAL HERPES
The First Outbreak
Symptoms usually develop within 2-20 days after contact, but could continue up to 2 weeks.
The first infection may be so mild it goes unnoticed. In other cases, the first attack causes visible sores. Subsequent recurrences of the virus may cause an outbreak of blisters.
The virus retreats into the nerves and lies dormant. Even when there are no symptoms of herpes, transmitting the virus is still possible (asymptomatic viral shedding).
Healing of the skin does not normally leave scarring.
Typical Symptoms
When it gets into skin cells the virus reproduces itself and starts to multiply, making the skin red and sensitive.
Blisters or bumps may appear on the genital area, the blisters first opening and then healing with the regeneration of new skin tissue.
During the outbreak the infected area may:
be painful
burn
itch
tingle
Other symptoms include:
fever
headache
infection of the urethra causing a burning sensation when urinating
muscle ache
painful inflamed blisters which develop around the infected area
swollen lymph glands
vaginal or penis discharge
The first episode is the most severe, with most episodes lasting 10-21 days. A warning sign (prodrome) such as tingling is experienced by many people in recurring outbreaks.
Should any of these symptoms occur, consult your doctor or other health care provider immediately.
Genital herpes should be diagnosed and treated professionally.
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Diagnosis/Testing
Diagnosis can be made by:
Blood Test
A blood test for herpes is available only in a few research centers.
Microscopic Examination of Tissue Scrapings
In this process, scrapings from lesions are stained and then examined under a microscope.
This test is less accurate than viral cultures, as it is difficult to ascertain which type of HSV infection is present.
One common test is called a Tzanck smear.
Results of the tests take up to 2 weeks.
Viral Cell Culture Test
The test is a specific virus culture or assay for herpes virus.
The doctor or health consultant will obtain fluid from the sores and send it to a laboratory to see if the herpes virus is present.
A viral culture is a fluid sample taken from a lesion when it first appears. Highly accurate results can be given from a culture taken while the lesion is still in the clear blister stage, but the process takes a few days.
The test will not work if the sores have healed.
Immune Response Tests
These tests detect the body's immune response to the herpes virus and are slightly less reliable than viral cultures, but more reliable than tissue scrapings.
Results can sometimes be provided in two hours.
Other available tests:
Antigen test
Pap Smear
Identifying Your Type
Not everyone knows whether they have HSV-1 or 2 and in certain situations that information could be relevant.
In a situation where both partners have HSV-2 both are already infected so precautions to prevent the spread of the disease are optional.
If one partner has genital HSV-1 and the other has HSV-2, each might get infected with a second type unless precautions are used.
HSV- 1
Diagnosing genital HSV- 1 is difficult because the infection seldom recurs. Since many people have HSV-1 orally, a finding of HSV-1 by Western blot serology (blood test) would not positively identify genital infection.
A Western blot confirms if you have HSV-2. If you are seronegative (negative by blood test) for type 2, but positive for type 1, that gives you a strong clue as to the cause of your outbreaks, i.e. seropositive for type 1 but not type 2, with infrequent recurring genital herpes is probably genital HSV1.
Seek immediate professional help if genital herpes is suspected. Some of the available diagnostic procedures become less reliable the longer you wait.
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