Genital Herpes

Genital Herpes

“It was the biggest shock of my life,” said Margaret C., a 48-year-old corporate librarian. “I wanted to go home & stay there, never see anyone again.” She was referring to the day her gynecologist told her that the itchy rash that had been troubling her for weeks was genital herpes. For many, the news that they have contracted a sexually transmitted disease (STD) such as genital herpes can be devastating. If they are monogamous, they may wrongly assume that their partner was responsible.

If they are single & dating they may fear informing prospective partners – while knowing they must. Other common worries for people with herpes are – dealing with the symptoms that brought them to the doctor in the first place, dealing with future outbreaks & the impact on having healthy children.

What Is Genital Herpes?

Herpes is caused by 2 types of herpes simplex virus (HSV-1 & HSV-2) & is usually a mild recurrent skin condition. Most oral herpes is caused by HSV-1 while most genital herpes is caused by HSV-2, but both types can occur in the genitals, mouth or both. Most of us get oral herpes during childhood by a simple kiss from friends or family. You can get genital herpes when someone with oral herpes (often a cold sore) gives you oral sex.

Genital herpes infection is so common in the US that 1 in 5 Americans age 12 & older are infected. Genital herpes is more common in women (about 1 in 4) than in men (almost 1 in 5), perhaps because male-to-female transmission seems to happen easier than female-to-male. In June 2001, US Centers for Disease Control & Prevention (CDC) noted genital herpes had increased 30% in 20 years.

Young white teens have herpes 5 times more often now, & it is twice as common in young adults (age 20-29). Most people infected with HSV-2 are not aware of their infection because they never have sores or they may have very mild signs that they don’t notice or mistake for insect bites or a rash. But if symptoms do happen right after infection, they can be quite obvious. The first episode is usually 2 weeks after the virus is transmitted, with sores healing in 2-4 weeks.

Other primary episode signs & symptoms may be a second outbreak of sores or flu-like symptoms, including fever & swollen glands. Most people diagnosed with a first episode of genital herpes have 4 or 5 symptomatic recurrences a year, most noticeable in the first year following the first episode.

Can genital herpes be serious?

While HSV-2 usually produces only mild symptoms or signs or no symptoms at all there can sometimes be recurrent painful genital sores, especially severe in anyone with suppressed immune systems. It is a misconception that HSV causes cancer, although HSV-2 might be a cofactor for cervical cancer. In rare instances HSV-2 can cause fatal infections in infants if the mother is shedding virus at delivery. HSV-2 also seems to play a major role in the heterosexual spread of HIV, the virus that causes AIDS.

Herpes does this by making people more open to HIV infection when being sexual with an HIV-infected individual.

How is genital herpes diagnosed?

Health care providers can diagnose genital herpes by visual inspection of an outbreak & taking a sample from the sore(s). HSV infections can be difficult to diagnose between outbreaks, so laboratory testing is recommended. However, blood tests that detect HSV-1 or HSV-2 are not always clear. Older blood tests for herpes are less accurate & even misleading. If you take a blood test for herpes ask if it is “type specific.” The latest FDA-approved tests are:

· POCkit™HSV-2 (manufactured by Diagnology) · HerpeSelect™-1 ELISA IgG or HerpeSelect™-2 ELISA IgG (manufactured by Focus Technology, Inc.) · HerpeSelect™ 1 & 2 Immunoblot IgG (manufactured by Focus Technology, Inc.).

Living With/Preventing Genital Herpes

Although there is still no cure for genital herpes, the Federal Drug Administration (FDA) has approved 3 anti-viral medications that are taken daily in pill form by mouth to reduce frequency & intensity of outbreaks:

· Zoviraxc™ (acyclovir) · Famvir™ (famciclovir) · Valtrex™ (valacyclovir).

CDC states that valacyclovir & famciclovir have enhanced absorption (more of the medicine gets used by your body). NOTE: topical (on the skin type) antiviral drugs are NOT recommended. FDA approved VALTREX® (valacyclovir HCl) caplets for a shorter course of therapy allowing effective treatment of recurrent episodes in 3 days versus the standard 5 days. VALTREX is also the only antiviral with once daily dosing to suppress recurrent genital herpes outbreaks.

It’s important for both women & men to know the risk of mother to child herpes transmission during pregnancy. The safety of taking acyclovir, valacyclovir, & famciclovir during pregnancy has not been established. The risk for transmission to the unborn child from an infected mother is high (30-50%) among women who acquire genital herpes near the time of delivery. Most specialists recommend that women who are having a recurrence of genital lesions when labor begins to deliver by cesarean section to prevent giving herpes to the infant (although risk for transmission is not completely eliminated).

CDC recommends that pregnant women who are not infected with HSV-2 should avoid intercourse during the third trimester with men who have genital herpes. Likewise, uninfected pregnant women should not have cunnilingus (oral sex on a woman) from a partner with oral herpes nor vaginal intercourse with a herpes-infected partner during the third trimester.

Besides medication, it is also important to take care of yourself by staying in good health (plenty of rest, regular exercise & a balanced diet). During outbreaks avoid using any creams or skin products on the affected areas because they can worsen things. Be sure to keep affected areas clean & dry. Baths are not advisable during outbreaks because herpes is so easily spread.

Change underwear daily and wash bath towels frequently. Managing stress with activities such as meditation, yoga, journal writing or even therapy can be effective against repeated herpes outbreaks. Some find help in natural remedies like dietary supplements and/or herbal extracts. Of course, before taking any natural remedies, consult your physician.

A vaccine is in the works that may eventually protect against genital herpes. There’s also promising research on a heat-activated, antimicrobial gel known as the “invisible condom,” which was able to prevent the transmission of HIV and herpes in the laboratory. http://www.cdc.gov/hiv/conferences/hiv99/abstracts/419.pdf

Although consistent, correct use of latex condoms is CDC’s recommendation to protect against infection, it’s not complete protection because the condom may not cover the herpes sore(s), and transmission can take place even without visible sores. No intercourse (vaginal or anal) or oral sex is best during obvious outbreaks. A report of the Genital Herpes Prevention Consultants Meeting (September, 1998) recommends either male or female condoms for protection all the time since most herpes transmission takes place between outbreaks when there are no apparent sores, called “subclinical viral shedding” or “asymptomatic viral shedding.”

People infected with herpes virus can benefit from local support groups, where others share their treatment experiences and offer advice on interpersonal issues. Many now find help online, but this is no substitute for face-to-face communication skills needed to disclose or discuss herpes with sex partners. There are several resources to find a group near you at the end of this update. If you need to find a skilled therapist able to help you along the way, go to the American Association of Sex Educators, Counselors, and Therapists (www.aasect.org) website for local referrals.

As for Margaret, she said learning the facts about the disease put her life back on track. “I calmed down and eventually learned to live with it,” she said. “I also joined a support group, which was really helpful. Then I met Ron, the man I’m currently seeing, and I was able to tell him about my condition. He’s been wonderful. We just don’t make love when I have an outbreak, which is fortunately very rarely. Everything is working out fine.”

Of course, not every potential sex partner is so accepting. Herpes is a contagious, incurable disease, which makes it unconscionable to keep it secret from a partner. No matter the precautions taken, you should explain that you have herpes (or any STD) before you have your first sexual encounter. Even with accepting partners, time and lots of detailed information are needed before the first sexual experience. On-going communication with both your lover and doctor is ideal. Becoming a sort of “expert” gives you added self-confidence to truly live in sexual health, even with herpes.

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