Herpes Simplex (HSV) – Types 1 and 2
Definition
Genital herpes is an infection that causes small, painful, fluid-filled blisters on the genitals, buttocks, or thighs. These blisters break open leaving an indented sore or ulcer. These blisters and/or ulcers may occur on other parts of the body, including the mouth, face, or eyes.
Genital Herpes
Causes
Genital herpes is caused by the herpes simplex virus. Although it was previously believed that type 1 was responsible for lesions from the waist up and type 2 for those from the waist down, this has been shown to be incorrect. Genital lesions may be of either type 1 or type 2, and some sources report that currently up to 40% of newly acquired cases of genital herpes are from type 1 virus. The virus enters the body through a break in the skin or through mucous membranes. After the first outbreak of genital herpes, the virus migrates to nerve endings at the base of the spine, and lies dormant until the next outbreak.
The virus is spread through:
• Sexual contact, including intercourse and oral and anal sex
• Fluid from herpes blisters that gets on other parts of the body
• An infected mother passing it on to her child during pregnancy or childbirth
The virus is most contagious when blisters are present. It is also contagious during the "shedding" stage, before blisters or sores are visible. The virus may also spread when inactive between outbreaks.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The strongest risk factor for getting the herpes simplex virus is unprotected sexual contact with a partner infected with the virus.
Once the herpes simplex virus is present in the body, other risk factors can trigger the blisters to form. Often, the exact cause of an outbreak of genital herpes is unknown.
Risk factors for an outbreak of genital herpes in people already infected with the virus include:
• Fever
• Illness or infection
• Stress
• Weakened immune system
• Menstruation
• Long periods of exposure to sunlight
Symptoms
Symptoms vary depending on whether this is the patient’s first (primary) episode or a recurrent episode. The virus remains dormant between outbreaks. During this period, the patient may not have any noticeable symptoms but may still be shedding (releasing) the virus and able to spread it to a sexual partner. When the virus is active, symptoms also vary and some people still have no symptoms. The frequency of genital herpes outbreaks varies from person to person. Most people have outbreaks at least once per year.
Primary Infection – This occurs in a patient who is newly exposed to HSV. Although there may not be any noticeable symptoms (asymptomatic), many people experience a flu-like syndrome, which includes fever and muscle aches. The lesions may be genital and/or present on other areas of the body, including the mouth, lips, and tongue. Additionally, the lesions are usually larger in size and number than those occurring in repeat or recurrent episodes. The primary infection usually resolves within two weeks unless the patient gets a second infection with a skin bacteria or fungus, in which case, the lesions may persist for up to six weeks.
Recurrent Infection – This represents a reactivation of the herpes virus. The recurrence will vary from patient to patient in terms of severity, duration, and amount of virus shed. In general though, recurrences tend to result in fewer, smaller ulcers which usually last only 3-7 days. Symptoms are usually limited to the area around the blister or ulcer. It is important to remember that viral shedding can occur with or without visible lesions and that asymptomatic (no symptoms or sores) lesions are currently responsible for over 50% of new infections.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam, particularly of the blisters and/or ulcers. Herpes lesions may look like other infections and may not be immediately visible if inside the urinary tract, vagina, or cervix. The doctor may need to open a blister to swab it and send it to the lab or may take a blood sample for testing.
Treatment
Treatments to ease pain include:
• Nonprescription pain relief drugs
• Antiviral creams and ointments
• Cool cloths placed on blisters or sores
• Lukewarm baths
• Wearing loose-fitting clothes
Treatments to speed healing include:
• Oral antiviral medications
• Keeping blisters/sores dry when not bathing
Treatments for bacterial infection of the blisters/sores include:
• Antibiotic medications
Prevention
To prevent the spread of the herpes simplex virus:
• Avoid sexual contact with an infected partner from the time the partner feels initial symptoms until blisters/sores have completely healed.
• If your partner is infected, use latex condoms during sex when your partner shows symptoms of genital herpes.
• Avoid oral sex if your partner has herpes blisters on the mouth or genital area.
• Avoid touching blisters to prevent spreading to other parts of the body.
• If you are pregnant and infected with the herpes virus, tell your doctor. Medication given to newborns immediately after birth can decrease the chance that they will be infected. If you have active herpes blisters when it is time to deliver your baby, the doctor may recommend that you deliver by Cesarean section.
