Genital herpes is on the rise. Since the late 1970s, the number of Americans infected with the virus has increased 30 percent to about 45 million, according to the Centers for Disease Control and Prevention (CDC).
Genital herpes infects more than one of five adolescents and adults, according to the CDC. It is more common in African Americans than in whites, and more likely to infect women than men. Compared to 20 years ago, it's about five times more common in 12- to 19-year-old whites and twice as common in adults ages 20 to 29.
The scary part is that most people with genital herpes don't know they have it, and are therefore unaware they might be spreading it to others, says Terri Warren, R.N., a specialist in treating sexually transmitted diseases.
Many people have no symptoms. Some mistake their symptoms for something else, such as jock itch, insect bites, hemorrhoids, yeast infections, razor burn, or allergies to laundry detergent.
Of even greater concern is the growing evidence that people with genital herpes are at greater risk of getting HIV (the virus that causes AIDS) if they have unprotected sex with someone infected with HIV. Additionally, HIV-infected people who are also infected with genital herpes might have more frequent and severe herpes outbreaks, which might be more difficult to treat.
What is Genital Herpes?
Genital herpes, a sexually transmitted disease (STD), is an infection caused by the herpes simplex virus (HSV). HSV is in the same family of viruses that causes chickenpox, shingles, and mononucleosis. Although HSV-1 oral herpes (cold sores) is typically found around the month, it can also infect the genital area through oral sex. HSV-2 genital herpes can infect the mouth through oral sex.
HSV can cause sores, or lesions, to appear in and around the vaginal area and within the cervix in women, and on the penis and scrotum in men. Both males and females can also get lesions in the urinary tract, around the anal opening, on the buttocks or thighs, and sometimes on other parts of the body.
The First Episode
Symptoms of genital herpes can vary in appearance and intensity. Some people have no symptoms or such mild symptoms that they don't know they have an infection. For others, the first episode of herpes (primary infection) can cause one or more very painful lesions to erupt on the skin.
For many people, this primary infection is more severe and has more symptoms than recurrent episodes. During a first episode, the lesions might be accompanied by flu-like symptoms such as fever, headache, and muscle aches. Some people experience painful or difficult urination and swollen glands in the groin area. Women can also have a vaginal discharge.
Genital herpes lesions usually appear within two to 10 days after being exposed to the virus, and can last from two to four weeks. Small red bumps appear first, and can develop into blisters. The blisters can become open sores, which later dry up, crust over, and heal without leaving a scar. Sometimes a second crop of lesions appears.
Recurrent Episodes
Once HSV infects a person, the virus travels through the nerves and settles at the base of the spine. During this inactive phase, the virus is dormant. But it may wake up later, travel along the nerve paths to the surface of the skin, and cause another outbreak of lesions. This recurrence of HSV usually causes lesions to appear around the same area of the first outbreak.
Some people have only one or two recurrences in a lifetime, while others have them frequently. "The recurrence rate is far lower in HSV-1 than HSV-2," says Rhoda Ashley, Ph.D., director of the University of Washington's viral diagnostic laboratory at the Children's Hospital and Regional Medical Center in Seattle.
Most people diagnosed with HSV-2 affecting the genital area typically have four or five symptomatic recurrences in the first year. After the first year, most have fewer and milder recurrences, lasting a week or less. Many people get warning signals of a recurrence, known as prodrome. With prodrome, there may be a tingling or itching in the genital area, or pain in the buttocks, down the legs, or in the lower back. Sometimes these symptoms go away and no lesions appear.
Researchers don't know why recurrences happen, or why their frequency and severity vary. Some people report that recurrences are triggered by stress, illness, poor nutrition, menstruation, and friction in the genital area, such as that caused by vigorous sex. However, many of these supposed triggers have no scientific basis, says Ashley.
Treatment
Although there is no cure for genital herpes, there are medications that significantly reduce the frequency of outbreaks, shorten their duration and severity, and have few side effects in most people.
The FDA-approved Zovirax (acyclovir) was the first genital herpes drug, and is now available in a generic form. Two more FDA-approved drugs are used to treat genital herpes: Famvir® (famciclovir) and Valtrex® (valacyclovir).
All three of these oral antiviral drugs can be taken either episodically – when a person has an outbreak or feels one coming on, or suppressively – daily to help prevent the recurrence of outbreaks. Acyclovir and valacyclovir are also FDA-approved to treat an initial episode of genital herpes to help heal the lesions and to lessen the pain. When taken episodically at the first sign of a tingling or itching sensation, an antiviral drug might prevent an outbreak altogether.
"Once an outbreak occurs, if the treatment is started soon enough, the drugs can lessen the severity and shorten the healing time," says Stanka Kukich, M.D., a medical team leader in the FDA's Center for Drug Evaluation and Research. When taken suppressively, the drugs don't always prevent outbreaks, but help them to occur less frequently.
All three of the drugs work by interfering with DNA synthesis to prevent the virus from reproducing, says Kukich. Famciclovir and valacyclovir, which are better absorbed by the body, can be taken less often than acyclovir.
Diagnosing Genital Herpes
In the past, genital herpes was diagnosed solely by visual inspection and laboratory culture of an active sore. It can now be diagnosed with a blood test, even when no symptoms are apparent or after sores have healed.
Herpes can still be detected by a viral culture of a lesion, if one is present. With a viral culture, a doctor swabs a lesion to pick up cells, puts the swab in a special solution, and sends it to a lab for growing and analyzing.
Although a doctor might recognize a herpes lesion by examining it, a viral culture will confirm the presence and type of HSV, says Ashley. Once they know whether they have HSV-1 or HSV-2, people have a better idea of how often they will have recurrences. But viral cultures do have their drawbacks. If the lesion has started to heal (usually 48 hours after its appearance), the swab may not pick up enough virus and the culture result will be a "false negative." (False positives in cultures are rare.)
A blood test can be used to confirm a negative culture. It can also be used to diagnose herpes in a person who has no symptoms, who has genital irritation but isn't sure if it's herpes, or who has a sexual partner with herpes and wants to find out if he or she has already become infected.
Some blood tests can determine the type of herpes infection, but cannot indicate whether the herpes is oral or genital. So people without symptoms might not know for certain if their herpes is oral or genital.
For help in locating a local support group, contact the Herpes Resource Center of the American Social Health Association. |
