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Sexually Transmitted Diseases (STDs) Genital HerpesGenital herpes is a contagious viral infection that affects an estimated 30 million Americans. Each year, as many as 500,000 new cases are believed to occur. The infection is caused by the herpes simplex virus (HSV). There are two types of HSV, and both can cause the symptoms of genital herpes. HSV type 1 most commonly causes sores on the lips (known as fever blisters or cold sores), but it can cause genital infections as well. HSV type 2 most often causes genital sores, but it can also infect the mouth. HSV 1 and 2 can both produce sores in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where broken skin has come into contact with HSV. The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people. Most people who are infected with HSV never develop any symptoms. Genital herpes infection is usually acquired by sexual contact with someone who has an outbreak of herpes sores in the genital area. People with oral herpes can transmit the infection to the genital area of a partner during oral-genital sex. Herpes infections can be transmitted by a person who is infected with HSV but has no noticeable symptoms. The virus is rarely spread by contact with objects such as a toilet seat or hot tub. SymptomsThe symptoms of genital herpes vary widely from person to person. When symptoms of a first episode of genital herpes occur, they usually appear within 2 to 10 days of exposure to the virus and last an average of 2 to 3 weeks. The early symptoms can include an itching or burning sensation; pain in the legs, buttocks, or genital area; vaginal discharge; or a feeling of pressure in the abdominal region. Within a few days, sores (also called lesions) appear at the site of infection. Lesions can also occur on the cervix in women or in the urinary passage in men. These small red bumps may develop into blisters or painful open sores. Over a period of days, the sores become crusted and then heal without scarring. Other symptoms that may accompany a primary episode of genital herpes can include fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area. RecurrencesIn genital herpes, after invading the skin or mucous membranes, the virus travels to the sensory nerves at the end of the spinal cord. Even after the skin lesions have disappeared, the virus remains inside the nerve cells in an inactive state. In most people, the virus reactivates from time to time. When this happens, the virus begins to travel along the nerves to the skin, where it multiplies on the surface at or near the site of the original herpes sores, causing new sores to erupt. It can also reactivate without causing any visible sores. At these times, small amounts of the virus may be shed at, or near, sites of the original infection, in genital or oral secretions, or from inapparent lesions. This shedding is infrequent, however, and usually lasts only a day, but it is sufficient to infect a sex partner. The symptoms of recurrent episodes are usually milder than those of the first episode and typically last about a week. A recurrent outbreak may be signaled by a tingling sensation or itching in the genital area or pain in the buttocks or down the leg. These are called prodromal symptoms, and, for some people, they can be the most painful and annoying part of a recurrent episode. Sometimes only the prodrome is present, and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable or may break into open sores that crust over and then disappear. The frequency and severity of the recurrent episodes vary greatly. While some people recognize only one or two recurrences in a lifetime, others may experience several outbreaks a year. The number and pattern of recurrences often change over time for an individual. Scientists do not know what causes the virus to reactivate. Although some people with herpes report that their recurrences are brought on by other illness, stress, or menstruation, recurrences often are not predictable. In some cases, exposure to sunlight is associated with recurrences. DiagnosisThe sores of genital herpes in its active stage are usually visible to the naked eye. Several laboratory tests may be needed, however, to distinguish herpes sores from other infections. The most accurate method of diagnosis is by viral culture, in which a new sore is swabbed or scraped and the sample is added to a laboratory culture containing healthy cells. After 1 or 2 days, when examined under a microscope, the cells will begin to show changes that indicate growth of the herpes virus. A newer, more rapid, but somewhat less accurate way of diagnosing herpes involves detection of viral protein components in lesion swabs. These tests should be done when the sores first appear to ensure reliable results. Other laboratory tests are also available to physicians to confirm the presence of HSV in the blood and to determine whether HSV 1 or 2 is present. A blood test cannot determine whether a person has an active genital herpes infection. A blood test can, however, detect antibodies to the virus, which indicate that the person has, at some time, been infected with HSV and produced antibodies to it. (Antibodies are proteins made by a person's immune system to fight infections.) Unlike antibodies to some other viruses, however, antibodies to HSV do not totally protect an individual against another infection with a different strain or a different type of herpes virus, nor do they prevent a reactivation of the latent virus. Antibody tests are the best way to determine if a person is an HSV carrier. New blood tests have been developed that can distinguish whether a person has had prior type 1 or type 2 infection, or both. However, these tests are available mainly in research hospitals and are not used routinely in the doctor's office. TreatmentDuring an active herpes episode, whether primary or recurrent, it is important to follow a few simple steps to speed healing and to avoid spreading the infection to other sites of the body or to other people:
In 1982, the first antiviral drug for genital herpes, acyclovir, was approved by the Food and Drug Administration for use as a topical ointment in persons suffering from an initial episode of infection. Over the next few years, investigators at the National Institute of Allergy and Infectious Diseases (NIAID) and elsewhere subsequently proved that an oral form of acyclovir is a superior treatment capable of benefitting persons with first or recurrent episodes of genital herpes. The oral form of the drug markedly shortens the course of a first episode and limits the severity of recurrences if taken within 24 hours of onset of symptoms. People who have very frequent recurrent episodes of the disease can also take oral acyclovir daily for up to one year to suppress the virus' activity and prevent most recurrences. Acyclovir is not a cure for herpes--the virus remains in the body, but while taken regularly, the drug interferes with the virus' ability to reproduce itself. ComplicationsGenital herpes infections do not cause permanent disability or long-term damage in healthy adults. However, in people who have suppressed immune systems, HSV episodes can be long-lasting and unusually severe. A pregnant woman who develops a first episode of genital herpes can pass the virus to her fetus and may be at higher risk for premature delivery. Newborns rarely become infected with herpes; however, half of those who do either die or suffer neurologic damage. With early detection and therapy, many serious complications can be lessened. The newborn's chances of infection depend on whether the mother is having a recurrent or a first outbreak. If the mother is having her first outbreak at the time of a vaginal birth, the baby's risk of infection is approximately one in three. If the outbreak is a recurrence, the baby's risk is very low. Because of the danger of infection to the baby, however, the physician will perform a cesarean section if herpes lesions are detected in or near the birth canal during labor. Some physicians also perform a viral culture at the time of delivery to detect shedding in women known to have had genital herpes outbreaks in the past. A baby born with herpes can develop encephalitis (inflammation of the brain), severe rashes, and eye problems. Acyclovir can greatly improve the outcome for babies with neonatal herpes, particularly if they receive immediate treatment. HSV and AIDSGenital herpes, like other genital ulcer diseases, increases the risk of acquiring HIV, the virus that causes AIDS, by providing an accessible point of entry for HIV. Persons with HIV can have severe herpes outbreaks, and this may help facilitate transmission of both herpes and HIV infections to other persons. PreventionPeople with early signs of a herpes outbreak or with visible sores should not have sexual intercourse until the sores have completely healed. Between outbreaks, use of condoms (rubbers) sexual intercourse is the best way to prevent infecting a partner. Counseling and help for those who have genital herpes is often available from local or state health departments. The American Social Health Association (ASHA) maintains the Herpes Resource
Center (HRC). For further information on HRC programs and their literature regarding herpes, send a
self-addressed stamped envelope to: ResearchScientists supported by NIAID are concentrating their efforts in several areas of investigation. One important goal is the development of a safe and effective vaccine for genital herpes. Results from early, small-scale testing of a promising new vaccine showed it to be safe and capable of stimulating an immune response in both infected and uninfected study participants. Current studies being conducted by researchers at NIAID and elsewhere are determining whether it will greatly reduce or eliminate genital herpes outbreaks in infected persons. Other scientists have developed an experimental test that can be used to screen blood samples for evidence of herpes infection and can accurately distinguish type 1 from type 2 infections. Rapid diagnostic tests have been developed that can detect active virus in a pregnant woman at the time of delivery. These tests may be able to identify exposed infants who should be observed carefully or receive immediate care. Researchers are still studying the potential of acyclovir for treating HSV while continuing to search for other antiviral drugs that may be effective against the herpes simplex virus. Several new drugs are being tested now to determine whether they would be more effective than acyclovir. For most people, genital herpes rarely progresses to serious consequences, except in newborns or in people with suppressed immune systems such as AIDS patients. Recurrences can, however, be distressing, inconvenient, and sometimes painful. Concern about transmitting the disease to others and disruption of sexual relations during active outbreaks of the sores can affect personal relationships. Although the fact that genital herpes can be a chronic condition may at first sound frightening, it is reassuring to know that with proper counseling, treatment, and preventive measures, the disease can be coped with and managed effectively. NIAID, a component of the National Institutes of Health, supports research on AIDS, tuberculosis and other infectious diseases as well as allergies and immunology. Prepared by: |
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