Genital herpes

Genital herpes is a sexually transmitted disease (STD) characterized by painful sores on the genitals. It's a lifelong infection that can cause repeated outbreaks. Although there's no cure for genital herpes, treatment is available.


Causes/associated factors
Genital herpes is caused by the herpes simplex virus (HSV). HSV-type 1 typically causes painful fever blisters on the face or mouth, while HSV-type 2 generally causes blisters in the genital area. Both types of the virus can cause oral or genital infections, however.
After you become infected with HSV, you may not experience any symptoms. If you do have symptoms, they'll typically be blisters in the area that was exposed to the virus. After your first outbreak, the virus is often dormant (inactive) and causes no symptoms. Some people have repeated outbreaks, however. Genital injury, menstruation, emotional stress, sunlight or other infections may trigger outbreaks. HSV-type 1 is less likely to recur than HSV-type 2.

Genital herpes affects about 45 million Americans age 12 and older. The risk of contracting genital herpes increases with the number of sexual partners you have, as well as the duration of each sexual encounter. Due to anatomical differences, women have a greater risk of contracting genital herpes than men.


Transmission
Genital herpes spreads through direct contact with an infected person who has the active virus, whether symptoms are present or not. The virus may spread through vaginal, oral and anal sex, as well as other types of skin-to-skin contact that expose mucous membranes to an open sore or infected body fluid (such as semen or vaginal fluid). The infection can also spread to other parts of the body. For example, you can spread the infection to your eye by touching a genital sore and then touching your eye with your infected finger.
Genital herpes is most contagious when you have blisters, sores or "warning" symptoms (called prodromal symptoms). After exposure, the incubation period (the time from exposure until symptoms appear, if they appear at all) is two to 12 days.


Signs/symptoms
Genital herpes often has no symptoms. If symptoms do appear, the most common is painful blistering in the genital area. The sores are sometimes hidden in the vagina, on the cervix, or in the urethra (the tube through which urine -- and semen, for males -- drains to the outside of the body).
Other symptoms may include:

a burning sensation during urination when sores are present
pain during sex
fever
swollen glands in lower abdomen and groin area
headache
a general feeling of discomfort
muscle pain
vaginal discharge
Scabs typically form on the open sores after three to five days. The sores heal in about three weeks and the virus becomes dormant. If the virus is reactivated, the symptoms are often less noticeable than they were during the initial outbreak and typically last about a week. You may even be warned of an approaching outbreak by symptoms such as burning, numbness, itching or tingling at the site of a previous sore. These warning symptoms usually occur about 24 hours before an outbreak. On average, there are four or five recurrences a year. Over time, these recurrences usually decrease.

The symptoms of genital herpes are sometimes mistaken for those of other problems, such as jock itch, a yeast infection, an ingrown hair or insect bites.


Diagnosis
The doctor will ask about your sexual history and the length and characteristics of your symptoms, as well as do a physical exam. Open sores may be swabbed for cells to be tested for the virus.
A blood test to measure antibodies to the herpes virus can be done to help distinguish between HSV-type 1 and HSV-type 2. It may take 12 to 16 weeks after your last exposure to obtain the most accurate results.

Because you can have several STDs simultaneously, the doctor may want to test for other conditions (such as HIV, the virus that causes AIDS) at the same time.


Treatment
There's no cure for genital herpes, but treatment is available. Antiviral medications such as acyclovir (Zovirax, for example), famciclovir (Famvir, for example) and valacyclovir (Valtrex, for example) can speed healing and reduce the frequency of recurring outbreaks.
For recurrent genital herpes outbreaks, the most effective treatment is to begin antiviral medication within one day of the appearance of new lesions or at the first sign of warning symptoms. Your doctor may give you a prescription for an antiviral medication so you can be prepared in case you have a recurrence.

For severe recurrent genital herpes, your doctor may recommend daily antiviral medication to suppress the frequency of outbreaks. Daily medication may also help reduce the risk of spreading herpes to your partner.

In addition to medication, your doctor may recommend the following self-care measures:

Keep the sores clean and dry.
Apply a cool compress or ice pack to the affected area.
Soak in a lukewarm bath.
Take over-the-counter pain medication as directed to relieve discomfort. Follow label instructions carefully. (Don't give aspirin to anyone age 19 or younger due to the risk of Reye's syndrome, a rare but serious condition.)
Minimize stress.
Avoid sunlight.
Remember, it's still possible to spread the virus while you're being treated -- even if you don't have noticeable sores.


Complications
Genital herpes increases the risk of contracting HIV, and can also make people infected with HIV more infectious. If you have a weak immune system, you may have severe or prolonged outbreaks or the herpes virus may spread to other organs.
Other complications may include:

inability to urinate
secondary bacterial infection of open sores
rarely, meningitis (inflammation of the membranes surrounding the brain or spinal cord)
rarely, encephalitis (inflammation of the brain)

Pregnancy-specific information
If you contract genital herpes near the end of a pregnancy, you may spread the infection to your baby. If you have warning or other symptoms of genital herpes at the time of delivery, notify your doctor immediately. Make sure the doctor who delivers your baby (not just the one who follows you through your pregnancy) knows you have a history of genital herpes.
To reduce the risk of spreading the virus to your baby, you may need a cesarean delivery. For a newborn, an HSV infection can lead to brain damage or blindness. In some cases, it can be fatal.


Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
Abstinence is the most effective way to prevent genital herpes. If you're sexually active, mutual monogamy with an uninfected partner will reduce the risk of contracting genital herpes and other sexually transmitted diseases. If you're not in a mutally monogamous relationship, reduce the risk of contracting genital herpes and other STDs by:
limiting your number of sexual partners
making sure each sexual partner is tested for STDs and completes proper treatment, if necessary, before you have sexual contact
using a latex or polyurethane condom consistently during any vaginal, oral or anal sexual contact
Keep in mind that a condom doesnricants may break down the latex in the condom.

If you have genital herpes, avoid spreading it to others by not having sex when lesions or warning symptoms are present. Notify your partner of your condition before having sex.