Herpes

According to the Centers for Disease Control genital herpes affects 45 million people in the United States. Most of these people are unaware that they have been infected with the virus. They may have no symptoms or mistake their symptoms for something else. Although there is no cure for genital herpes, medications are available that can decrease the severity of symptoms and incidence of recurrences.

There are two kinds of herpes simplex viruses. HSV-1 typically causes oral lesions (cold sores) whereas HSV-2 causes lesions on the genitals. However, either virus can cause oral or genital lesions.

Symptoms of genital herpes include painful sores and burning with urination. These symptoms can be mistaken for a urinary tract infection or other types of vaginal infections if an exam is not done. The sores may be single or in clusters. They may be on the external genitals, thighs, and buttocks or in the anal area. Some women may notice a difference in vaginal discharge. The first infection (called the primary infection) may be associated with a low-grade fever, generalized flu like symptoms or enlarged lymph glands in the groin area. It can take several weeks for the lesions to heal completely. Looking at the lesions and sending a swab of the lesion for culture will confirm a diagnose of genital herpes. Many people have no symptoms after being infected with the herpes virus.

After the primary infection (whether symptomatic or not), infected individuals may have no further outbreaks, continue to periodically shed the virus without symptoms or have periodic outbreaks of herpes lesions. The outbreaks can be infrequent or occur many times a year. Recurrent episodes of genital herpes are less severe than primary episodes. Many people will have what is called prodromal symptoms prior to a recurrent episode, burning, tingling or an uncomfortable feeling in the area a lesion will eventually develop. Recurrent episodes occur because the virus, after causing the genital or oral sores, ascends through peripheral nerves and gets into nerve cells called ganglia. While the virus is in the ganglia, it is in a latent period of its lifecycle and does not cause any symptoms. It is not clear what causes the virus to become reactivated and cause formation of the genital sores but is likely a combination of viral and human factors.

Genital herpes is a sexually transmitted disease. It can be spread via oral or genital contact with the virus. Avoiding sexual contact in the presence of active herpes lesions is essential. As the virus can be shed without any symptoms, consistent use of condoms can decrease the risk of infection.

The initial infection (called a primary infection) typically produces the worst symptoms but some people never have symptoms when they are initially infected with the virus. These people may present with symptoms more consistent with a recurrent outbreak. There are blood tests that can help distinguish between primary and recurrent outbreaks of genital herpes but in practice they are not particularly useful in treating patients. It is not known why some people have no or few symptoms of herpes infection.

Treatment of herpes infections involves alleviating symptoms and decreasing the length and frequency of recurrences. There are several anti-viral medications that can be used for this. Although not curable, herpes is not a life threatening disease. Often people will recognize the prodromal symptoms of a herpes outbreak and thwart it with anti-viral medications. People with frequent recurrences can be treated with a daily medication to decrease the number and severity of infections.