GENITAL HERPES

Aarthi (2012)

What is genital herpes?

Genital herpes (herpes genitalis) is an acute inflammatory disease of the male and female genital tract caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2).

Etiology
- It is caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). - Following the classification HSV into two distinct categories of HSV-1 and HSV-2 in the 1960s, it was established that "HSV-2 was below the waist, HSV-1 was above the waist". -HSV-2 is usually transmitted venereally or maternally to newborn infants and is responsible for genital herpes and neonatal infections. - Although genital herpes is largely believed to be caused by HSV-2, genital HSV-1 infections are increasing and now exceed 50% in certain populations.

How do people get genital herpes?

-People

get herpes by having sex with someone who has the disease. Having sex means anal, vaginal, or oral sex. -HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause. The viruses can also be released from skin that does not appear to have a sore. -Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. -Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

-HSV-1 can cause sores in the genital area and infections of the mouth and lips, so-called fever blisters. HSV-1 infection of the genitals is caused by mouth to genital or genital to genital contact with a person who has HSV-1 infection. - Transfer to a fetus/newborn from an infected mother. Vaginal herpes lesions are a particular risk for infants born to mothers with the lesions. - People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom.

How common is genital herpes?

-Genital herpes infection is common in the United States. Nationwide, 16.2%, or about one out of six, people aged 14 to 49 years have genital HSV2 infection. -Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. Because of this, genital HSV-2 infection is more common in women (approximately one out of five women aged 14 to 49 years) than in men (about one out of nine men aged 14 to 49 years). - Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms of an active infection.

What Happens in an HSV Infection?

-Genital herpes virus is passed from one person to another through sexual contact. This happens even if the person with the virus doesn't have symptoms or signs of infection. -Once the virus enters through the skin, it travels along nerve paths. It may become dormant (inactive) in the nerves and remain there indefinitely.

-From time to time, the virus may become active. When that happens, the virus travels back along the nerve path to the surface of the skin, where additional virus is shed. -At this point the virus may cause an outbreak of symptoms. Or it may remain undetected. -In either case, the active virus is easily passed from one partner to another through sexual contact. Even wearing a condom may not protect the uninfected partner. The virus can be present on skin that remains uncovered.

What Are the Symptoms of Genital Herpes?

-HSV is believed to be asymptomatic in the majority of cases, thus aiding contagion and hindering containment.
-These usually appear 47 days after sexual exposure to HSV for the first time. Genital HSV-1 infection recurs at rate of about one sixth of that of genital HSV-2 -Even though you can still pass the infection on, you may never notice symptoms from an HSV infection. On the other hand, you might notice symptoms within a few days to a couple of weeks after the initial contact. Or you might not have an initial outbreak of symptoms until months or even years after becoming infected.

-When symptomatic, the typical manifestation of a primary HSV-1 or HSV-2 genital infection is clusters of genital sores consisting of inflamed papules and vesicles on the outer surface of the genitals, resembling cold sores. They may start as small blisters that eventually break open and produce raw, painful sores that scab and heal over within a few weeks. -In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. - In females, lesions appear on or near the pubis, labia, clitoris, vulva, buttocks or anus. - The blisters and sores may be accompanied by flu-like symptoms with fever and swollen glands.

-Any of the following symptoms of a genital HSV infection can occur in a man or a woman: Cracked, raw, or red areas around the genitals without pain, itching, or tingling Small blisters that break open and cause painful sores. These may be on or around the genitals (penis or vagina) or on the buttocks, thighs, or rectal area. More rarely, blisters may occur inside the urethra. Headaches Backaches Flu-like symptoms, including fever, swollen glands, and fatigue
-Genital herpes is not the only condition that can produce these symptoms. The only way to know whether they are the result of HSV or another condition is to be checked by a health care provider. Genital herpes is diagnosed with a physical exam and typically confirmed with a swab test.

Differential Diagnosis
Syphillis Chancroid Lymphgranuloma Venerum Granuloma Inguinale Molluscum Contagiosum Scabies Genital Warts Candidiasis Herpes Zoster

Seborrheic Dermatitis Lichen Planus Bacterial Folliculitis Trauma Lice Allergic contact dermatitis Erythema Multiforme Balanitis Circinata Sicca of Reiters Syndrome Psoriasis Bowenoid Papulosis Ecchymosis and Purpura secondary to intercourse

Syphillis

Chancroid

Lymphgranuloma Venerum

Molluscum Contagiosum

Scabies

Genital Warts

Candidiasis

Herpes Zoster

Seborrheic Dermatitis

Lichen Planus

Balanitis Circinata Sicca of Reiters Syndrome

Bowenoid Papulosis

Diagnostics
-Many doctors will begin treatment based only on the appearance of the sores, if the sores seem typical of herpes. -Doctors may take a swab of the sore and send the swab to the laboratory to see if the virus is present. - A number of types of tests may be ordered to establish the diagnosis, including: a culture of the virus; polymerase chain reaction to demonstrate the genetic material of the virus; and tests using antibodies to the genital herpes virus to demonstrate the presence of the virus in clinical specimens In some cases, blood tests to confirm the presence of an immune response to the herpes virus may be ordered. - A person may still have genital herpes, however, even if the laboratory tests don't show the virus in the body.

Treatment
-Presently, genital herpes cannot be cured. Moreover, genital herpes can be transmitted by viral shedding prior to and following the visual signs of symptoms.
-There are however some drugs that can shorten outbreaks and make them less severe or even stop them from happening. Among these drugs are: acyclovir, valacyclovir and famciclovir.

Acyclovir is an antiviral drug used against herpes viruses, varicella-zoster, and Epstein-Barr Viruses. This drug reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, suspension, injection, powder for injection, and ointment. The ointment is used topically and it decreases pain, reduces healing time, and limits the spread of the infection.
Valacyclovir is also used to treat herpes virus infections. Once in the body, it becomes the antiherpes medicine, acyclovir. It helps relieve the pain and discomfort and the sores heal faster. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir.

Famciclovir is another antiviral drug that belongs to the same class of acyclovir and valacyclovir. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. This drug has a longer duration of action than acyclovir and it only comes in tablets.

Immunity

-There is no immunity against genital herpes