Herpes

Herpes simplex virus (HSV) is a virus that infects the skin and mucous membranes (mouth, genital areas, etc.) of humans. Most genital herpes infections are caused by herpes simplex virus type 2 (HSV-2). HSV-2 is a sexually transmitted infection. Although HSV-2 typically causes genital infections, it can also cause oral infections that can then be spread by non-sexual activities like kissing. Similarly, although HSV-1 usually causes oral herpes infections, it can be transmitted to the genitals via oral sex, thereby becoming a sexually transmitted infection. Unlike many other sexually transmitted infections that are spread by exposure to infected body fluids, HSV is commonly spread by skin-to-skin contact. When a person who has HSV present on his/her body comes in contact with someone who is not infected, the virus (and the infection) may spread. In addition to HSV infection in the oral and genital areas, HSV infection may also occur on the abdomen, thighs, hands and other areas. The greatest risk factor for genital herpes infection is the total number of lifetime sexual partners a person has had. Women seem to be at greater risk for infection than do men.5

The earliest symptoms of an initial genital herpes infection may include fever, headache and muscle aches that begin six to seven days after exposure. About eight days after exposure, lesions appear in the area of exposure. These lesions usually begin as small blisters, which break and become ulcers. The ulcers are painful and often burn or itch. Other genital symptoms include burning with urination, vaginal or urethral discharge and tender swollen lymph nodes in the groin area. Symptoms of the initial infection typically resolve within two to three weeks.6 Recurrent outbreaks of herpes skin lesions are common, but are usually not preceded by the fever, headache and muscle aches that generally precede the initial outbreak. When someone visits a physician with symptoms of genital herpes (painful ulcers in the genital area), viral cultures or other tests to establish the presence of the virus can confirm the diagnosis. Unfortunately, as many as 90 percent of people with genital herpes do not know they are infected.7 Tests for detecting herpes infection in patients without symptoms are available, but not widely used. In individuals (or groups of individuals) known to be at high risk of infection, it may be appropriate to test people who don’t have symptoms of genital herpes to reduce the chance of unknowingly infecting a sexual partner. There is no cure for genital herpes. Treatment with anti-viral medications like Acyclovir reduces the duration and intensity of symptoms. Long-term treatment with these medications can decrease the frequency of recurrences and asymptomatic viral shedding.8

Once a person is infected with HSV-2 (s)he is probably infected for life and can transmit the infection to others even at times when (s)he is not experiencing symptoms. Approximately 90 percent of individuals with an initial symptomatic HSV-2 infection will experience at least one recurrence of symptoms within the 12 months following the initial episode, and 38 percent have at least six recurrences in the first year.9 Recurrence rates decrease over time, but recurrences can occur for the remainder of the person’s life.10 An additional consequence of genital herpes infection is that infected individuals are at increased risk of contracting HIV, the virus that leads to AIDS.11 They may also be more likely to spread HIV to others.12 Finally, mothers with genital herpes can transmit the infection to their newborn infants. This risk is greatest with primary (first-time) infections. With recurrent infections, the risk is less than 1 percent.13 Infected newborns are quite sick and often die. Genital herpes infection of the mother also increases the risk of both spontaneous abortion and premature birth.14

Based on the limited studies, it appears condoms only reduce the risk of acquiring genital herpes through sexual activity by half at best if they are used consistently and correctly.  However, since the virus is transmitted by skin-to-skin contact, condoms are likely to be less effective in reducing the transmission of herpes than they are for infections transmitted by body fluids.16 Condoms do not cover all the skin in the genital area, and sex with an infected person can result in an infection, even when condoms are used. If you have already been sexually active outside a lifelong mutually faithful relationship (as in marriage), talk to your healthcare provider about getting you and your partner tested for STDs. Abstinence from sexual activity--including oral sex--or lifetime faithfulness to one uninfected partner is the only certain way to avoid being infected sexually. Read more at http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm

1. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337:1105-1111. 2. Ibid. 3. Ibid. 4. American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation; 1998. 5. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337:1105-1111. 6. Corey L, Wald A. Genital Herpes. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co.; 1999:285-312. 7. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337:1105-1111. 8. Corey L, Wald A. Genital Herpes. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co.; 1999:285-312. 9. Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994;121:847-854. 10. Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med. 1999;131:14-20. 11. Eng TR, Butler WT, eds. The Hidden Epidemic – Confronting Sexually Transmitted Disease. Institute of Medicine. Washington, DC: National Academy Press; 1997. 12. Schacker T, Ryncarz AJ, Goddard J, Diem K, Shaughnessy M, Corey L. Frequent recovery of HIV-1 from genital herpes simplex virus lesions in HIV-1-infected men. JAMA. 1998;280:61-66. 13. Corey L, Wald A. Genital Herpes. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, New York: McGraw Hill, Co.; 1999:285-312. 14. Ibid. 15. Oberle MW, Rosero-Bixby L, Lee FK, Sanchez-Braverman M, Nahmias AJ, Gunan ME.  Herpes simplex virus type 2 antibodies: High prevalence in monogamous women in Costa Rica.  Am J Trop Med Hyg. 1989;41:224-229. 16. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337:1105-1111.

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