Genital herpes

Infection by herpes simplex viruses of the genitals

The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected. Sores are not required for transmission to occur. HSV is classified into two types, HSV 1 and HSV 2. Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies. Once infected, there is no cure. In the United States, more than one in six people between the ages of 14 and 49 have the disease. Women are more commonly infected than men. In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash. Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined. People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir. People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy. Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency. Internal condoms for the vagina may be used during oral sex or vaginal sex. People who have sexual relations with others may get tested for HSV. In people who have been diagnosed with genital herpes, transmission to others may be prevented through suppressive antiviral drugs. Herpes simplex virus testing is recommended for those who have symptoms of herpes or who have a sexual partner who has a herpes infection.

Women who have genital herpes before pregnancy have a very low risk of transmitting herpes simplex virus to the baby during delivery. In the United States, 20 25% of pregnant women have genital herpes; however, fewer than 0.1% of babies born get neonatal herpes during delivery. Per the U. S. Preventive Services Task Force, routine screening for pregnant women without a history of genital herpes is not recommended. Serologic (blood) antibody testing in asymptomatic patients without history has been shown to frequently have false positive and false negative test results which may lead to anxiety, labeling, or false reassurance with minimal improvements in health outcomes of reducing neonatal herpes transmission. Pregnant women should notify their doctor if they show symptoms of genital herpes. At the time of delivery, women should be physically examined for signs of genital herpes. These medications are acyclovir, valacyclovir, and famciclovir and have been shown to be safe with long term use. Acyclovir is an antiviral medication and 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, and ointment. However, topical ointment with acyclovir is discouraged since it offers minimal clinical benefits. Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. 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. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets.

The first time an individual experiences genital herpes, they may have prolonged clinical illness with severe genital ulceration. Long term use of anti virals like acyclovir, valacyclovir, and famciclovir have been shown to be safe and effective. Furthermore, long term treatment of genital herpes with valacyclovir daily has shown to decrease the rates of transmission. It is important for patients to continue suppressive therapy in conjunction to consistent condom use and sexual abstinence during recurrent episodes to decrease transmission as well. More than 85% of those with HSV 2 are unaware of their infection. Approximately 776,000 people in the United States get new herpes infections every year. Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not.

Early 20th century public health legislation in the United Kingdom required compulsory treatment for sexually transmitted infections but did not include herpes because it was not serious enough. As late as 1975, nursing textbooks did not include herpes as it was considered no worse than a common cold.