What is it?
Herpes is a viral infection of the skin caused by the Herpes Simplex Virus (HSV). Classically, HSV-1 caused a mouth and lip rash (i.e., cold sore - pictured below), while HSV-2 caused the genital herpes. Over the last decade, it has become clear that either strain of this virus can cause either rash, though 75% of genital herpes is caused by HSV-2. One in five of us in the general population has genital herpes while almost three out of four people have a history of cold sores caused by the Herpes virus. As expected, one’s sexual history determines the prevalence of the genital form of this infection. In other words, while only 3% of nuns have genital herpes, 80% of prostitutes have it.
Common Signs & Symptoms
Herpes is spread by skin-to-skin contact. Unfortunately, most exposure occurs when there is no identifiable rash (e.g., when the person is asymptomatic) as there is shedding of the virus through the skin
about 1% of the time. (Click on the images for a more detailed view.)
After exposure to the virus, a 2 to 20 day incubation period ensues followed by the primary genital herpes outbreak. Only 50% of those infected will have significant enough symptoms to know they are infected. Symptoms of primary genital herpes may include fever, headache, and muscle aches followed 3 days later by the classical rash (pictured) of painful blisters and ulcerations of the skin where the infection occurred.
Tender and swollen groin glands (lymph nodes) then develop about a week after the skin rash. The rash and pain usually completely goes away over 3 to 4 weeks.
Unfortunately, the virus then hangs around in the nerves, often causing a reinfection from time to time. This recurrent genital herpes usually begins with a burning or itchy sensation 1 - 2 days before the skin rash develops. Recurrent herpes is less painful and less severe than the primary infection.
One terrible manifestation of this viral infection occurs in babies delivered through the birth canal of an infected woman. Though relatively rare in women who are not having an outbreak at delivery, neonatal herpes (infection of the newborn) often causes a whole-body and brain infection in the baby. There is a high death rate for infants infected and of those that live, there is often residual mental retardation and blindness. To decrease the risk of this awful disease, a Cesarean (C-section) delivery should be done in pregnant women who go into labor and have a genital herpes outbreak at the same time.
How’s it Diagnosed?
Diagnosis is made by a physician when hearing the symptoms of the rash and examining the blistered area. If there is any question, a sample of the abnormal tissue (biopsy) can be sent to the lab for microscopic analysis. A viral culture of the wound can also be checked to verify the presence of the Herpes Simplex Virus.
How’s it Treated?
Like most viral infections, there is no cure for Herpes. Anti-viral medications have come to market lately and have done a very good job at improving the duration of an outbreak as well as the discomfort. Medications such as acyclovir (Zovirax), famcyclovir (Famvir), valacyclovir (Valtrex), and others can significantly lessen the pain and symptoms and shorten the course of the herpes outbreak. The pills can also be used to prevent recurrences. Though technically used for genital herpes only, these medicines are commonly given at the first sign of an oral herpes sore to shorten the course and pain. Intravenous acyclovir is used in newborns infected during delivery.
A new medication is currently being studied for the treatment of herpes. If you have a history of herpes, and are interested in possibly joining the study, check out herpestrial.com.
How do I avoid Getting It (Prevention)?
Abstinence will prevent transmission of genital herpes from one person to the next. Using condoms correctly (covering all the infected skin areas), and avoiding sexual activity when sores are present will significantly decrease the risk of infection, but will not entirely eliminate the risk.
An exciting new preventative technique is also quickly approaching. A number of studies have found a vaccine against herpes is effective in women (interestingly, the studies show no real benefit for men). Within the next year, it is quite likely that younger women may begin to be vaccinated with this herpes vaccine to decrease the risk of catching this viral infection. Ask your doctor, or contact SmithKline Beecham (manufacturer of this vaccine) for more info and on the status of this vaccination.
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