Let's talk about STDs - Herpes Genitalis (III)

Common names:

• Genital Herpes
• Herpes Genitalis
• Herpes Groin
• Herpes Simplex Type 2  

 What Is Genital Herpes?

Genital herpes is an infection of the *genitals, *buttocks, or *anal area caused by herpes simplex virus (HSV). Most genital herpes is caused by HSV type 2. Yet as people begin to have sex at younger ages the herpes type 1 virus has increasingly been shown to also cause genital herpes.  Photos

 

 Causes

Genital herpes is a highly contagious infection usually spread through intercourse, but it can be passed through oral or anal sex as well. Learn about it in this sexual health article.

• Are You at Risk?   

Herpes Can Increase the Risks of HIV Infection  STDs can increase the risk of HIV. People with genital herpes have at least twice the risk of becoming infected with HIV if exposed to it than those without it.  Read more about herpes and HIV infection.
 Related Guide: Your Guide to STDs
One out of four teens in the United States becomes infected with an STD each year and by the age of 25, half of all sexually active young adults will get an STD.
Tool: Are You at Risk of Genital Herpes?
This brief questionnaire will let you know.
Related Guide: What Increases Your Risk of Herpes
Lots of risk factors can increase your risk of genital herpes. Stress, fatigue, and being a woman are herpes risk factors, read more.
Risks Associated With Oral Sex and Genital Herpes
Receiving oral sex raises women’s genital herpes risk, a study shows.
Rare Circumcision Ritual Carries Herpes Risk
Male infants can become infected with the herpes simplex virus type 1 (HSV-1) after undergoing circumcision that included direct oral-genital contact between the infant and the circumciser. Read more about circumcision and herpes risks. 

• Prevention

STDs can be spread by people who don't know they are infected. Always use protection every time you have sex, including oral sex, until you are sure you and your partner are not infected with an STD.
If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention  Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sex partner doesn't have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

•  How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had unprotected oral sex?
• Have you had more than one sex partner at a time?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you had a test for HIV? What were the results?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven't had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
• Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. A condom is the best way to protect yourself from STDs. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for an STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

  Symptoms and Types

What are the symptoms of genital herpes? Can you get herpes from someone who doesn’t show signs of the disease?  What problems can herpes cause? Find answers here.

• Symptoms

Herpes Symptoms

Learn the full range, from mild to severe.

      Signs of genital herpes tend to develop within three to seven days of skin-to-skin contact with an infected person.
      Genital herpes infections look like small blisters or ulcers (round areas of broken skin) on the genitals. 
       Each blister or ulcer is typically only 1 - 3 millimeters (1/32 inch to 1/8th inch) in size, and the blisters or ulcers tend to be grouped into "crops." Usually the blisters form first, then soon open to form ulcers. Herpes infections may be painless or slightly tender. In some people, however, the blisters or ulcers can be very tender and painful.

Location of genital herpes

• In men, genital herpes sores (lesions) usually appear on or around the penis.
  
  
• In women, the lesions may be visible outside the vagina, but they commonly occur inside the vagina where they can cause discomfort or vaginal discharge but cannot be seen except during a doctor's examination.
  
  
• The ulcers or blisters may also be found anywhere around the genitals (the perineum) and in and around the anus.

First outbreak of genital herpes

The first genital herpes outbreak is usually the most painful, and the initial episode may last longer than later outbreaks. Symptoms may last for two to four weeks.
Some people develop other signs of genital herpes infection, particularly with the first episode including:

• fever,
  
  
• muscle aches,
  
  
• headaches (may be severe),
  
  
• vaginal discharge or painful urination, and
  
  
• swollen and tender lymph nodes in the groin (these swell as the body tries to fight the infection).

Later outbreaks of genital herpes

• If the disease returns, later outbreaks generally have much less severe symptoms. Many people with recurrent disease develop pain or a tingling sensation in the area of the infection even before any blisters or ulcers can be seen. This is due to irritation and inflammation of the nerves leading to the infected area of skin.
  
  
• These are signs that an outbreak is about to begin. The condition is particularly contagious during this period, even though the skin still appears normal.

Types

Learn the difference between the two types of herpes simplex virus.

•  HSV type 1 (HSV-1). This is the type that usually causes cold sores or fever blisters around your mouth, though it can be spread to your genital area during oral sex.

•  HSV type 2 (HSV-2). This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious whether or not you have an open sore. However, in many people the infection causes no recognized signs or symptoms and can still be spread to a sexual partner.

Because the virus dies quickly outside of the body, it's nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.

• Complications 

        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 lead to potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a newly acquired infection during late pregnancy poses 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.Herpes may play a role in the 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.

Diagnosis and Tests

Most sexually active people with genital ulcers have herpes, syphilis, or chancroid. But not all genital ulcers are caused by STDs.  Here’s what to expect when tested.

• Diagnosis

Preparing for Your Doctor Visit

Print out this page before you go -- includes illustrations and questions your doctor may ask.

10 Questions to Ask Your Doctor

Whether you’re newly diagnosed or living with frequent genital herpes outbreaks, you’ll want answers.

• Tests

What Do Herpes Tests Mean?

Up to half of all first episodes of genital herpes are caused by HSV-1, yet recurrences occur less frequent for genital HSV-1 infection than for HSV-2. Testing for HSV type can influence prognosis and counseling.

Tests to Diagnose Genital Herpes

         Accurate testing is important for genital herpes. Being told you're infected when you're not, or the other way around, can be awful. Some people have lived decades under the false impression that they were infected because a doctor didn't test them for the virus. Instead, they were diagnosed by their symptoms alone. It's easy to mistake genital herpes symptoms for something else.

         If you have sores on your genitals, a doctor can take a sample from a sore and look for the herpes simplex virus (HSV) in it. One test is called a cell culture. Any viruses in the sample are allowed to multiply so that they're easy to find under a microscope. There are other tests, such as PCR, available as well.

The direct fluorescent antibody test is another kind.

Blood Tests for Genital Herpes

•  A false-negative result from a blood test is possible if you have been infected recently. It takes several weeks for HSV antibodies to show up in the blood.

• False-positive test results are possible, too. If you test positive, but your risk for getting the virus is low, you may need to be tested again.

These tests are of limited use because they only show that you have been exposed to the virus at some point.  It is difficult to tell from these tests when the exposure may have occurred.  You may have had HSV for many years before you have your first noticeable outbreak.
 

Tzanck and PCR Tests

          Other ways to detect the herpes virus include the Tzanck test and the PCR test (mentioned above).

• A Tzanck test places a sample from a sore on a microscope slide and stains it with a dye. Cells that are infected with HSV look different from those that aren't. This test is not very accurate and has largely been replaced by culture and PCR testing.

• The PCR (polymerase chain reaction) test looks for pieces of the virus' DNA. It's an accurate test, but can be technically difficult to collect and run.

•  New tests on the horizon include one that can detect HSV in saliva and urine. It was developed recently by a doctor at the London School of Hygiene and Tropical Medicine for use in a safe-sex study in Africa. The test has not been marketed to the public.

• Read more about Tests

Treatment and Care

Medications can reduce the duration and frequency of herpes outbreaks. They can also help reduce the risk of HSV type 2 transmission to a susceptible partner.  

• Treatment

Herpes Medication

Antiviral drugs and how they’re administered.

Herpes Medication Chart

Side effects and interaction information for the most common antivirals.

Related Web Site: Counseling the Couple

People infected with HSV might express anxiety over genital herpes; the psychological effect of HSV infection can be substantial. Read the recommendations about counseling which apply to people with this infection.
Related links :

• SMART LIVING WITH GENITAL HERPES 

• Genital Herpes  http://www.cdc.gov/std/herpes/stdfact-herpes.htm
• Genital Herpes Health Center http://www.webmd.com/genital-herpes/default.htm