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Herpes (Genital Herpes, HSV-1, HSV-2)
An estimated one million people are
newly infected with the Herpes Simplex Virus (HSV)
each year. While most people have mild or unrecognized
symptoms and remain undiagnosed, many individuals seek
medical attention when they begin to suffer from the
painful ulcers characteristic of this viral disease.
What is genital herpes?
Genital herpes is a sexually transmitted
disease (STD) caused by the herpes simplex viruses type
1 (HSV-1)
and type 2 (HSV-2). Most individuals have no or only
minimal signs or symptoms from HSV-1 or HSV-2 infection.
When signs do occur, they typically appear as one or
more blisters on or around the genitals or rectum.
The blisters break, leaving tender ulcers (sores) that
may take two to four weeks to heal the first time they
occur. Typically, another outbreak can appear weeks
or months after the first, but it almost always is
less severe and shorter than the first outbreaks. Although
the infection can stay in the body indefinitely, the
number of outbreaks tends to decrease over a period
of years.
How do people get genital
herpes?
HSV-1 and HSV-2 can be found in and
released from the sores that the viruses cause, but
they also are released between outbreaks from skin
that does not appear to be broken or to have a sore.
Most genital herpes is caused by HSV-2. A person
almost always gets HSV-2 infection during sexual
contact with someone who has a genital HSV-2 infection
but may not know that they are infected and may not
have a visible sore.
HSV-1
can cause genital herpes, but it more commonly causes
infections of the mouth and lips, so-called “fever
blisters.” HSV-1 infection of the genitals can
be caused by oral-genital or genital-genital contact
with a person who has HSV-1 infection. Genital HSV-1
outbreaks recur less regularly than genital HSV-2 outbreaks.
How common is genital herpes?
Results of a nationally representative study show
that genital herpes infection is common in the United
States. Nationwide, at least 45 million people ages
12 and older, or one out of five adolescents and adults,
have had genital HSV infection. Between the late 1970s
and the early 1990s, the number of Americans with genital
herpes infection increased 30 percent.
HSV-2 infection is more common in women (approximately
one out of four women) than in men (almost one out
of five). This may be due to male-to-female transmissions
being more efficient than female-to-male transmission.
What
are the signs and symptoms of genital herpes?
Most people infected with HSV-2 are not aware of their
infection. However, if signs and symptoms occur during
the first outbreak, they can be quite pronounced. The
first outbreak usually occurs within two weeks after
the virus is transmitted, and the sores typically heal
within two to four weeks. Other signs and symptoms
during the primary episode may include a second crop
of sores, and flu-like symptoms, including fever and
swollen glands. However, most individuals with HSV-2
infection may never have sores, or they may have very
mild signs that they do not even notice or that they
mistake for insect bites or another skin condition.
Most people diagnosed with a first episode of genital
herpes can expect to have several outbreaks (symptomatic
recurrences) a year (typically four or five). Over
time these recurrences usually decrease in frequency.
What
are the complications of genital herpes?
Genital herpes can cause recurrent painful genital
sores in many adults, and herpes infection can be severe
in people with suppressed immune systems. Regardless
of severity of symptoms, genital herpes frequently
causes psychological distress in people who know they
are infected.
In addition, genital HSV can cause potentially fatal
infections in babies if the mother has sores at the
time of delivery. It is important that women avoid
contracting herpes during pregnancy because a first
episode during pregnancy causes a greater risk of transmission
to the baby. If a woman has active genital herpes at
delivery, a cesarean delivery is usually performed.
Fortunately, infection of a baby from a woman with
herpes infection is rare.
Worldwide, herpes may play a role in the heterosexual
spread of HIV, the virus that causes AIDS. Herpes can
make people more susceptible to HIV infection, and
it can make HIV-infected individuals more infectious.
How
is genital herpes diagnosed?
The signs and symptoms associated with
HSV-2 can vary greatly. Health care providers can diagnose
genital
herpes by visual inspection if the outbreak is typical,
and by taking a sample from the sore(s) and testing
it in a laboratory. HSV infections can be difficult
to diagnose between outbreaks. Blood tests, which detect
HSV-1 or HSV-2 infection, may be helpful, although
the results are not always clear-cut.
Is there a treatment
for herpes?
There is no treatment that can cure
herpes, but antiviral medications can shorten and prevent
outbreaks during
the period of time the person takes the medication.
How
can herpes be prevented?
The surest way to avoid transmission
of sexually transmitted diseases, including genital
herpes, is to abstain from
sexual contact, or to be in a long-term mutually monogamous
relationship with a partner who has been tested and
is known to be uninfected.
Genital ulcer diseases can occur in both male and
female genital areas that are covered or protected
by a latex condom, as well as in areas that are not
covered. Correct and consistent use of latex condoms
can reduce the risk of genital herpes only when the
infected area or site of potential exposure is protected.
Since a condom may not cover all infected areas, even
correct and consistent use of latex condoms cannot
guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity
with uninfected partners when lesions or other symptoms
of herpes are present. It is important to know that
even if you do not have any symptoms you can still
infect your sex partner. Even if there are no symptoms,
sex partners of infected persons should be advised
that they may become infected. Partners can seek testing
to determine if they are already infected with HSV,
or are still at risk for acquiring HSV. A positive
HSV-2 blood test would mean that they probably have
genital herpes; however, a positive HSV-1 blood test
means that they have probably been infected with HSV-1,
but the infection could be genital or it could be oral.
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If you think you may have a sexually
transmitted disease, you should see a physician immediately
to be properly diagnosed and treated. You should
not try to diagnose or treat symptoms on your own.
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