Genital Herpes: Know the FACTS

By: Ordella Hawkins, MSN ARNP - UCF Health Center Women's Clinic Practitioner

Herpes Simplex: Getting the Facts
In the United States, approximately 60 million people are infected with genital herpes, 50 million with HSV-2 and 10 million with HSV-1. HSV-1 can also cause sores on the mouth or lips which are called cold sores or fever blisters, and is responsible for five to ten percent of genital herpes cases, most often as a result of oral-genital contact.

Genital Herpes Symptoms: More than Just Blisters
Genital herpes symptoms vary from person to person, although they usually include the formation of painful lesions, or ulcers. Even before the first lesion develops, people may experience itching or burning in the genital area, or pain in the legs or buttocks. Women may experience vaginal discharge. Abdominal pressure is also common. Other symptoms that occur during the first outbreak can include fever, headaches, painful urination, or swollen inguinal lymph nodes (those in the genital region). The initial outbreak is usually the most severe, with subsequent outbreaks being milder; in some cases blisters don't even form. The virus is transmitted by skin-to-skin contact, and easily transmitted during sex. It causes blisters and sores on the genitals, around the anus and often down the buttocks and thighs. People often assume that herpes sores and blisters must be present for the disease to be transmitted. Unfortunately, this just isn't true: seventy percent of all infections occur during outbreaks without any visible symptoms. Even though symptoms are not visible, the virus is still present both on the skin and in bodily fluids.

How Infection Occurs
The herpes virus can pass through a break in your skin during vaginal, oral, or anal sex. It can enter the moist membranes of the penis, vagina, urinary opening, cervix, or anus.
Once the virus gets into your body, it infects healthy cells. Your body's natural defense system then begins to fight the virus. This causes sores, blisters, and swelling.
Besides the sex organs, genital herpes can affect the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body. During oral sex, herpes can be passed from a cold sore around the mouth to a partner's genitals or vice versa. You even can infect yourself if you touch a sore and then rub or scratch another part of your body, especially your eyes.

Subsequent Outbreaks
After the initial infection, the virus goes into remission. It withdraws into nerve cells at the bottom of the spinal cord and lies dormant until the next outbreak. Most people experience three or four outbreaks of the virus every year. Outbreaks vary in severity—some lucky people have outbreaks so mild that they don't even notice any symptoms—and usually last a week.

Taking a Herpes Test
Herpes infections should be documented by blood testing or viral culture. A negative culture does not necessarily preclude infection. Type-specific and non-type specific antibodies to HSV develop during the first several weeks post-infection, and persist indefinitely. Antibodies are typically present in 50% of patients at 3 weeks, 70% of patients at 6 weeks and 95% of patients at 12-16 weeks.

Intercourse, Abstinence and Herpes Prevention
During an outbreak of genital herpes, the best way to avoid transmitting the disease is to abstain from sexual contact of any kind until the infection runs its course and the virus returns to a state of dormancy. All forms of sex, including oral sex, should be avoided until the lesions have shed their scabs and the skin beneath has completely healed. Limiting sexual partners also reduces the chance of transmission.

Herpes Prevention and Condoms
The correct and regular use of latex condoms can greatly reduce the risk of both transmitting and contracting HSV 2. A condom should always be worn during sex if either partner carries the virus, whether it appears to be active at that time or not. Although the use of latex condoms can reduce the risk of transmission, a condom will only protect against infections on the penis and vagina. No condom will prevent exposure to lesions on the thighs or buttocks, for instance.

Herpes Prescriptions: Episodic and Suppression Therapies
There is no cure for genital herpes, but there are treatments for its symptoms. Herpes prescriptions are used in two ways: as episodic treatments and for long-term suppression therapy. Episodic therapy treats individual outbreaks of HSV 1 & 2, decreasing the pain and duration of the viral outbreak, and significantly shortening healing time. Episodic therapy works best if medication is begun as early as possible during the outbreak.

Suppression therapy is helpful for individuals who experience frequent outbreaks. A smaller dose of medication is given than for episodic therapy, as the medication is taken over a longer period of time. This ensures that, should an outbreak occur, the medication is already present in the body. Suppression therapy has been proven to drastically reduce the frequency of outbreaks.