Genital Herpes

Genital Herpes

Until AIDS appeared, the late 1970s and early 1980s was a period of herpes hysteria. It was the most common sexually transmitted disease in the country; and it struck young, single, and usually middle-class men and women. Herpes captured immense media attention and terrified young, sexually active singles. The public was always more frightened by herpes than was the medical community, who considered herpes a discomfort rather than a dangerous or life-threatening infection. The exception to this statement is congenital herpes. Babies born to first-time infected mothers may have serious, life-threatening illness.

Herpes simplex virus type 2 is responsible for 85 percent of genital herpes. Type 1, which causes most herpes infections above the waist, is responsible for the other 15 percent.

How Do You Get It?

It is spread by contact with the genital secretions of a person who has active lesions. Sometimes a person in the latent phase, who has no symptoms, will also shed virus and can infect a sex partner. The virus can infect any skin or mucous membrane surface on your body, and will, depending on your sexual practices. Someone with a cold sore who engages in oral sex can give genital herpes to a partner.

How Do You Know If You Have It?

Genital herpes often begins with a tingling, itching, or prickling sensation in the area where the virus enters your body. In a few days, a raised cluster of small blister-like painful sores will appear at this spot. You may have several groups of clusters. Eventually the sores will crust over and dry. During a first attack some people have an overall sick feeling with swollen glands in the pelvic area and fever, tiredness, headache, muscle aches, or nausea.

Neonatal herpes is the term given to herpes infection in newborns. It can take many different forms. About one-third of such babies will have skin, eyes, or mouth lesions before any other symptoms. Another third will have brain infection (encephalitis), pneumonia, or infection in other major organs including the liver, but not skin, eye, or mouth lesions. The other third will have both. Common herpes symptoms in newborns are respiratory distress, fever, skin vesicles, or convulsions.

Tests

Doctors often diagnose herpes by symptoms alone, but there are several laboratory methods available:

■ The doctor can take a specimen from the base of a herpes lesion, and a virology lab can identify a type of cell called giant cells which usually indicates herpes virus.
■ Herpes grows rapidly in tissue culture. Specimens from a newly erupted herpes lesion will be identified in 24 to 28 hours in the viral lab.
■ Blood tests will look for antibodies to herpes. The newest blood tests can distinguish between type 1 and type 2 antibodies.
There are about 500,000 new cases of herpes in the United States every year and probably about 20 million infected Americans. Genital herpes most often hits 15- to 29-year-olds and is more common in women than men.

How Sick Will You Be?

Many people who are infected have no symptoms. Probably only 40 percent of people with antibodies to herpes ever have symptoms.

The first, or primary, episode is usually the worst, with severe local symptoms, and many painful lesions. These last at least ten days. It may take two to three weeks to completely get over this first attack of herpes. But when the sores go away, the virus remains in your body, and you enter the latent phase.

Most people have a recurrence within six months of their first episode. Some people have many recurrent episodes, some only a few, and some people have no more herpes eruptions after the first. You don’t have an overall sick feeling with recurrent episodes, which last about half as long as primary attacks (about four to five days), and only a few lesions occur. Some people have warning signs about two days before a lesion comes on. These prodromal symptoms include itchiness, pain, or tingling in the area.

If you have no antibodies to herpes simplex 1 (cold sores), you will be sickest during your first attack of genital herpes. Women usually have lesions on their cervix or vulva. Recurrences will appear on the vulva, perineal skin (between vagina and anus), upper thighs, anal area, or buttocks. Men get lesions on the glans penis, shaft of the penis, or anus.

People who are infected with herpes simplex 1 have fewer symptoms and milder outbreaks when they are later exposed to genital herpes. This explains why some people who have no symptoms themselves are shedding virus and are able to infect their partner.

Incubation Period

The incubation period is 2 to 12 days, although you often don’t know when you were exposed because your partner may not be aware of symptoms. In infants symptoms begin from one day to one month after birth. The worst diseases start within the first seven days of life.

Infectiousness

You’re infectious until your sores are completely healed, usually about 7 to 12 days. With recurrent episodes you are infectious for about 4 to 7 days. It was recently found that many recurrent infections are asymptomatic; that is, you don’t notice any sores, but you are shedding virus and can give herpes to your partner. Many herpes infections are caught from partners who do not have symptoms.

Immunity

You develop antibodies after herpes infection, but these antibodies do not prevent recurrence. However, they may prevent another primary infection if you are reexposed.

Complications

Rarely, herpes meningitis (infection in the lining of the spinal cord and brain) or herpes encephalitis (infection in the brain) follows initial herpes infection. Possible signs include stiff neck, severe headache, change in consciousness, lethargy, or irritability. Report any of these signs to your doctor.

In the past doctors thought that a woman with herpes infection was at higher risk of developing cancer of the cervix, and they advised these women to have Pap tests every 6 months as a precaution. New studies show that genital herpes probably has no role in causing cervical cancer.

How Do You Treat It?

The antiviral drug acyclovir (Zovirax) became available in the mid-1980s to treat herpes. Acyclovir is not a cure—it does not kill the virus—but it does reduce the severity of symptoms. It comes in ointment, capsule, liquid, and IV forms. Capsules are usually prescribed to treat primary genital herpes or a severe recurrence or to suppress a severe, frequent recurrence.

You take 200-mg capsules five times a day for ten days in a first attack of herpes. If you take acyclovir at the first sign of a recurrence—that is, during the tingling phase before the lesion pops up—it shortens the time to healing from four to five days to one to one-and-a-half days.

People with more than six recurrences a year may take acyclovir daily (400 mg twice a day) to prevent recurrence. If you are on daily suppressive therapy, you must see your doctor for reevaluation once a year because recurrence may become less frequent as time goes by. Usually, you don’t take daily acyclovir for more than three years. Very few people report side effects when taking acyclovir.
IV acyclovir is used for severe primary genital herpes for hospitalized patients.

Acyclovir is given intravenously for 14 to 21 days to babies bom with, or exposed to, herpes during birth.

Nursing Care

Here are some ways to feel better during a herpes attack:

■ Take frequent sitz baths in lukewarm water. Dry the sores with a hair dryer set on cool.
■ Put a small amount of petroleum jelly on the sores to reduce the irritation during urination. For very painful sores, ask your doctor for an anesthetic ointment (Xylocaine) which you should apply, for a few days only, to the sores to relieve pain during urination.
■ Wear loose cotton underwear. Women should avoid pantyhose and tight pants until the sores heal.

Herpes is not viewed with quite as much consternation in the 1990s as it once was because now we have not only a medicine to treat it, but also a lot more information on the infection. Still, people with herpes tend to be upset when they are told this diagnosis. So if someone you care for has herpes, it’s important to give them support and understanding. Ask your doctor for any new information about herpes.

You won’t get genital herpes if you have sex with only one partner who is not infected with herpes. Because many people do not have symptoms and may not even know they have herpes, this is easier said than done. Always use condoms if you are unsure of your partner’s status. Do not have sex while either you or your partner have active lesions.

If you become infected, it is important to inform your partner. There is no medicine to take to prevent infection after exposure. Some researchers are developing a herpes vaccine, but we have no idea when, if ever, this vaccine will be licensed for use.

During an outbreak, do not engage in sex until all your lesions have healed. You are much more likely to infect a partner while you have active lesions, and you are also much more likely to be infected by a partner with another STD when you have lesions in your genital area. This is particularly true for HIV infection. Other viruses or bacteria are able to get into your bloodstream via the open sores.
Recommendations for Herpes-Infected Pregnant Women. During pregnancy it is your responsibility to protect your baby from infection by not engaging in unprotected sex with a possibly infected partner. First episodes of herpes are much more dangerous to the fetus than recurrent episodes in a previously infected woman.

When you become pregnant, be sure to tell your doctor if you have ever had a herpes outbreak. This way, you can be closely watched for a herpes outbreak during your pregnancy and at the time of delivery. Women with recurrent herpes infection but no lesions at delivery can have vaginal deliveries. They require a vaginal herpes culture taken on the day of delivery. If the culture is positive for herpes, the baby may be treated with acyclovir to prevent infection. This preventive treatment is controversial, and there is no proof that it works.

Women with herpes lesions near delivery but before they go into labor require cervical cultures every three to five days. If the cultures show no evidence of herpes infection, they can deliver vaginally.
Women with herpes lesions at the time they go into labor require cesarean section to prevent the baby from being infected during delivery through the herpes-infected birth canal.

If there is any suspicion of active herpes at the time of delivery, your baby should not have a scalp fetal monitor placed. In some reports, babies were infected when the scalp electrode, which passed through the mother’s vagina, carried the herpes virus to the baby’s scalp.