Genital herpes

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Genital herpes
Other namesAnogenital herpesviral infection, herpes genitalis
SOA-Herpes-genitalis-female.jpg
An outbreak of genital herpes affecting the vulva
Specialty Infectious disease
Symptoms None, small blisters that break open to form painful ulcers, flu-like symptoms [1] [2]
Complications Aseptic meningitis, increased risk of HIV/AIDS if exposed, neonatal herpes [1]
Usual onset2–12 days after exposure [1]
DurationUp to 4 weeks (first outbreak) [1]
Causes Herpes simplex virus (HSV-1, HSV-2) [1]
Diagnostic method Testing lesions, blood tests for antigen [1]
Differential diagnosis Syphilis, chancroid, molluscum contagiosum, hidradenitis suppurativa [3]
PreventionNot having sex, using condoms, only having sex with someone who is not infected [2]
Treatment Antiviral medication [1]
Frequency846 million (2015) [4]

Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). [1] Most people either have no or mild symptoms and thus do not know they are infected. [1] When symptoms do occur, they typically include small blisters that break open to form painful ulcers. [1] Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. [2] Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. [1] Once infected further outbreaks may occur but are generally milder. [1]

Contents

The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected. [1] This may occur during sex, including anal, oral, and manual sex. [1] [5] Sores are not required for transmission to occur. [1] The risk of spread between a couple is about 7.5% over a year. [6] HSV is classified into two types, HSV-1 and HSV-2. [1] While historically HSV-2 was more common, genital HSV-1 has become more common in the developed world. [1] [7] Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies. [1]

Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected. [2] Once infected, there is no cure. [2] Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur. [1] The long-term use of antivirals may also decrease the risk of further spread. [1]

In 2015, about 846 million people (12% of the world population) had genital herpes. [4] In the United States, more than one in six people between the ages of 14 and 49 have the disease. [8] Women are more commonly infected than men. [1] Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010. [1] Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed to HIV-positive individuals, and spread to the baby during childbirth resulting in neonatal herpes. [1]

Signs and symptoms

Genital herpes affecting the penis SOA-Herpes-genitalis-male.jpg
Genital herpes affecting the penis

In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus. [2]

Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise. [9] Women often experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal intercourse. [9]

After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts. [9] In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash. [10] [11] Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined. [10]

Recurrence

After a first episode of herpes genitalis caused by HSV-2, there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%. [12] Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year. [12]

People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir. [13] Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor. [13] People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy. [14] Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency. [14]

Transmission

Genital herpes can be spread by viral shedding prior to and following the formation of ulcers. The risk of spread between a couple is about 7.5% over a year (for unprotected sex). [6] The likelihood of transferring genital herpes from one person to another is decreased by external condom use by 50%, by internal condom by 50%, and refraining from sex during an active outbreak. [6] The longer a partner has had the infection, the lower the transmission rate. [6] An infected person may further decrease transmission risks by maintaining a daily dose of antiviral medications. [6] Infection by genital herpes occurs in about 1 in every 1,000 sexual acts. [6]

Prevention

Because herpes simplex virus (HSV) infection is common and not routinely screened for in the general population, complete prevention of the transmission of genital herpes is difficult. To reduce the chance of contracting herpes simplex virus, external condoms for the penis may be used during oral sex, vaginal sex, and anal sex. [15] Internal condoms for the vagina may be used during oral sex or vaginal sex. [15] Internal condoms and external condoms should not be used simultaneously. [15] Dental dams may be used during oral sex involving the vagina or anus. [15] Decreasing the number of sexual partners a person has may also decrease the chance of contracting HSV. [16] People who have sexual relations with others may get tested for HSV. In people who have been diagnosed with genital herpes, transmission to others may be prevented through suppressive antiviral drugs. [17] This option is 90% effective in preventing the transmission of HSV and is a commonly used option for sexual and/or romantic partners or those who plan on becoming pregnant. [17] Those who are aware that they have genital herpes should notify their partner(s). [17]

Screening and diagnosis

Genital herpes may be diagnosed through a physical examination by a doctor or through a herpes simplex virus (HSV) test by sampling fluid within a genital blister or blood for HSV antibodies. [17] Herpes simplex virus testing is recommended for those who have symptoms of herpes or who have a sexual partner who has a herpes infection. [8] There is currently no recommendation for asymptomatic screening for genital herpes. [8]

False negative test results may occur if the test is performed late in the course of the illness or if the test sample is not appropriately acquired. [17] Testing people for HSV when they are asymptomatic is not recommended due to the high false-positivity rate. [18] A false positive test may cause relationship difficulties. [18]

Genital herpes and pregnancy

Women who have genital herpes before pregnancy have a very low risk of transmitting herpes simplex virus to the baby during delivery. In the United States, 20-25% of pregnant women have genital herpes; however, fewer than 0.1% of babies born get neonatal herpes during delivery. [19]

Per the U.S. Preventive Services Task Force, routine screening for pregnant women without a history of genital herpes is not recommended. Serologic (blood) antibody testing in asymptomatic patients without history has been shown to frequently have false positive and false negative test results which may lead to anxiety, labeling, or false reassurance with minimal improvements in health outcomes of reducing neonatal herpes transmission.[ citation needed ]

Pregnant women should notify their doctor if they show symptoms of genital herpes. At the time of delivery, women should be physically examined for signs of genital herpes. [19] If a pregnant woman is symptomatic during delivery, a Cesarean section is the safest method of preventing contact and transmission of herpes simplex virus between the mother and the baby. [19] Alternatively, some physicians use the drug acyclovir to treat pregnant women with genital herpes at 36 weeks until delivery to prevent the recurrence of symptoms and reduce the risk of transmission during delivery. [19] Acyclovir is not approved for this purpose by the FDA; however, acyclovir's manufacturer has tracked pregnant women who have taken the drug during pregnancy, and there is no evidence that shows any risks for the infant. [19]

Acyclovir may help reduce the frequency of symptomatic recurrence near term but may not definitively protect against transmission in all cases. This may be favorable particularly for women who prefer to have a vaginal delivery instead of cesarean section.[ citation needed ]

Treatment

There is no cure for the disease. Skin lesions disappear without treatment within a few weeks, but treatment accelerates the healing of lesions, reduces symptoms, and helps prevent or reduce recurrent outbreaks of the disease. Antiviral medications provide clinical benefits to those who are symptomatic and is the primary means of management once infected. The main goal for the use of antiviral medications is to treat the first outbreak or to prevent genital herpes recurrences, improve quality of life, and help suppress the virus to sexual transmission to partners. Three FDA-approved antiviral medications have clinical benefits in controlling the signs and symptoms of genital herpes when used for first clinical symptoms and recurrent episodes or when used as daily suppressive therapy. [20] These medications are acyclovir, valacyclovir, and famciclovir and have been shown to be safe with long-term use.

Acyclovir is an antiviral medication and reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, and ointment. However, topical ointment with acyclovir is discouraged since it offers minimal clinical benefits.

Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir. [21]

Famciclovir is another antiviral drug that belongs to the same class. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets. [22]

First clinical episode of genital herpes

The first time an individual experiences genital herpes, they may have prolonged clinical illness with severe genital ulceration. [20] Furthermore, for those who have mild clinical symptoms initially may experience severe recurrent infections later. Typical recommended regimens for first clinical episodes of genital herpes may be something like: [20]

Acylovir 400 mg orally 3 times per day for 7–10 days or
Valacyclovir 1g orally 3 times per day for 7–10 days or
Famciclovir 1g orally 2 times per day for 7–10 days

A treatment longer than 10 days may be recommended if the genital ulcers have not fully healed.

Recurrent genital herpes

Most individuals who experience a symptomatic first episode of genital herpes will experience recurrence of genital lesions at some point in the future. Asymptomatic shedding can also occur where an individual may not have genital ulcerations present but still possibly transmit the virus to other partners. It is important for patients to have a discussion with their primary care doctor for options of receiving either episodic treatment or long-term suppressive therapies. [20]

Suppressive therapy for recurrent genital herpes

Suppressive therapy has been shown effective in reducing recurrent genital herpes in as high as 80% which can tremendously help in improving quality of life since patients claim having minimal symptomatic episodes. [23] [24] Long-term use of anti-virals like acyclovir, valacyclovir, and famciclovir have been shown to be safe and effective. Furthermore, long-term treatment of genital herpes with valacyclovir daily has shown to decrease the rates of transmission. [25] It is important for patients to continue suppressive therapy in conjunction to consistent condom use and sexual abstinence during recurrent episodes to decrease transmission as well. [20]

Over-the-counter and non-drug treatments

To decrease symptoms during an outbreak of genital herpes, people can use an ice pack on the affected areas, take a warm bath, keep the genitals dry when not bathing, and take over-the-counter pain relief medication such as ibuprofen or acetaminophen. [17]

Epidemiology

About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted infections. [26] More than 85% of those with HSV-2 are unaware of their infection. [27] Approximately 776,000 people in the United States get new herpes infections every year. [27]

Tests for herpes are not routinely included among STI screenings. Performers in the pornography industry are screened for HIV, chlamydia, and gonorrhea with an optional panel of tests for hepatitis B, hepatitis C and syphilis, but not herpes. Testing for herpes is controversial since the results are not always accurate or helpful. [28] Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not. [29]

History

Early 20th century public health legislation in the United Kingdom required compulsory treatment for sexually transmitted infections but did not include herpes because it was not serious enough. [30] As late as 1975, nursing textbooks did not include herpes as it was considered no worse than a common cold. [30] After the development of acyclovir in the 1970s, the drug company Burroughs Wellcome launched an extensive marketing campaign that publicized the illness, including creating victim's support groups. [30]

Research

There are efforts to develop a vaccine for active outbreaks of the virus—despite most cases being asymptomatic—but the results thus far have not been able to do so or eliminate transmission. [31]

Related Research Articles

<span class="mw-page-title-main">Aciclovir</span> Antiviral medication used against herpes, chickenpox, and shingles

Aciclovir, also known as acyclovir, is an antiviral medication. It is primarily used for the treatment of herpes simplex virus infections, chickenpox, and shingles. Other uses include prevention of cytomegalovirus infections following transplant and severe complications of Epstein–Barr virus infection. It can be taken by mouth, applied as a cream, or injected.

<span class="mw-page-title-main">Valaciclovir</span> Antiviral medication

Valaciclovir, also spelled valacyclovir, is an antiviral medication used to treat outbreaks of herpes simplex or herpes zoster (shingles). It is also used to prevent cytomegalovirus following a kidney transplant in high risk cases. It is taken by mouth.

<span class="mw-page-title-main">Herpetic whitlow</span> Medical condition

A herpetic whitlow is a herpes lesion (whitlow), typically on a finger or thumb, caused by the herpes simplex virus (HSV). Occasionally infection occurs on the toes or on the nail cuticle. Herpes whitlow can be caused by infection by HSV-1 or HSV-2. HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions. It is also often observed in thumb-sucking children with primary HSV-1 oral infection (autoinoculation) prior to seroconversion, and in adults aged 20 to 30 following contact with HSV-2-infected genitals.

<span class="mw-page-title-main">Herpetic gingivostomatitis</span> Medical condition

Gingivostomatitis is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis which is often the subsequent presentations. Primary herpetic gingivostomatitis is the most common viral infection of the mouth.

<span class="mw-page-title-main">Famciclovir</span> Chemical compound

Famciclovir is a guanosine analogue antiviral drug used for the treatment of various herpesvirus infections, most commonly for herpes zoster (shingles). It is a prodrug form of penciclovir with improved oral bioavailability. Famciclovir is marketed under the trade name Famvir (Novartis).

<span class="mw-page-title-main">Herpes simplex virus</span> Species of virus

Herpes simplex virus1 and 2, also known by their taxonomic names Human alphaherpesvirus 1 and Human alphaherpesvirus 2, are two members of the human Herpesviridae family, a set of viruses that produce viral infections in the majority of humans. Both HSV-1 and HSV-2 are very common and contagious. They can be spread when an infected person begins shedding the virus.

A genital ulcer is an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents. However, this is not always the case, as a genital ulcer may have noninfectious causes as well.

Herpes gladiatorum is one of the most infectious of herpes-caused diseases, and is transmissible by skin-to-skin contact. The disease was first described in the 1960s in the New England Journal of Medicine. It is caused by contagious infection with human herpes simplex virus type 1 (HSV-1), which more commonly causes oral herpes. Another strain, HSV-2 usually causes genital herpes, although the strains are very similar and either can cause herpes in any location.

<span class="mw-page-title-main">Mollaret's meningitis</span> Medical condition

Mollaret's meningitis is a recurrent or chronic inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Since Mollaret's meningitis is a recurrent, benign (non-cancerous), aseptic meningitis, it is also referred to as benign recurrent lymphocytic meningitis. It was named for Pierre Mollaret, the French neurologist who first described it in 1944.

<span class="mw-page-title-main">Herpes</span> Viral disease caused by herpes simplex viruses

Herpes simplex, often known simply as herpes, is a viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are oral herpes and genital herpes, though other forms also exist.

Neonatal herpes simplex, or simply neonatal herpes, is a herpes infection in a newborn baby caused by the herpes simplex virus (HSV), mostly as a result of vertical transmission of the HSV from an affected mother to her baby. Types include skin, eye, and mouth herpes (SEM), disseminated herpes (DIS), and central nervous system herpes (CNS). Depending on the type, symptoms vary from a fever to small blisters, irritability, low body temperature, lethargy, breathing difficulty, and a large abdomen due to ascites or large liver. There may be red streaming eyes or no symptoms.

<span class="mw-page-title-main">Herpes meningitis</span> Medical condition

Herpes meningitis is inflammation of the meninges, the protective tissues surrounding the spinal cord and brain, due to infection from viruses of the Herpesviridae family - the most common amongst adults is HSV-2. Symptoms are self-limiting over 2 weeks with severe headache, nausea, vomiting, neck-stiffness, and photophobia. Herpes meningitis can cause Mollaret's meningitis, a form of recurrent meningitis. Lumbar puncture with cerebrospinal fluid results demonstrating aseptic meningitis pattern is necessary for diagnosis and polymerase chain reaction is used to detect viral presence. Although symptoms are self-limiting, treatment with antiviral medication may be recommended to prevent progression to Herpes Meningoencephalitis.

<span class="mw-page-title-main">Herpes simplex encephalitis</span> Encephalitis associated with herpes simplex virus

Herpes simplex encephalitis (HSE), or simply herpes encephalitis, is encephalitis due to herpes simplex virus. It is estimated to affect at least 1 in 500,000 individuals per year, and some studies suggest an incidence rate of 5.9 cases per 100,000 live births.

<span class="mw-page-title-main">Cold sore</span> Herpes simplex virus infection of the lip

A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.

The epidemiology of herpes simplex is of substantial epidemiologic and public health interest. Worldwide, the rate of infection with herpes simplex virus—counting both HSV-1 and HSV-2—is around 90%. Although many people infected with HSV develop labial or genital lesions, the majority are either undiagnosed or display no physical symptoms—individuals with no symptoms are described as asymptomatic or as having subclinical herpes.

<span class="mw-page-title-main">Herpes esophagitis</span> Medical condition

Herpes esophagitis is a viral infection of the esophagus caused by Herpes simplex virus (HSV).

<span class="mw-page-title-main">Herpes simplex keratitis</span> Medical condition

Herpetic simplex keratitis is a form of keratitis caused by recurrent herpes simplex virus (HSV) infection in the cornea.

<span class="mw-page-title-main">Pritelivir</span> Chemical compound

Pritelivir is a direct-acting antiviral drug in development for the treatment of herpes simplex virus infections (HSV). This is particularly important in immune compromised patients. It is currently in Phase III clinical development by the German biopharmaceutical company AiCuris Anti-infective Cures AG. US FDA granted fast track designation for pritelivir in 2017 and breakthrough therapy designation 2020.

<i>Human alphaherpesvirus 2</i> Species of virus

Human alphaherpesvirus 2 or Herpes simplex virus 2 is a species of virus in the genus Simplexvirus, subfamily Alphaherpesvirinae, family Herpesviridae, and order Herpesvirales.

References

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  2. 1 2 3 4 5 6 "STD Facts – Genital Herpes". 2017-12-11. Retrieved 30 October 2018.
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  14. 1 2 2007 National Guideline for the Management of Genital Herpes. Archived 2015-09-23 at the Wayback Machine By Clinical Effectiveness Group at British Association for Sexual Health and HIV.
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