Wednesday, May 9, 2012

Herpes Simplex

Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles.
In general:

  • ·        HSV-1 is acquired orally, causing cold sores.
  • ·        HSV-2 is acquired during sexual contact and affects the genital area.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries.
Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners.

Genital herpes symptoms and signs

If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:
·        Itching or tingling sensations in the genital or anal area;

  • ·        small fluid-filled blisters that burst leaving small painful sores (see STD pictures);
  • ·        pain when passing urine over the open sores (especially in women);
  • ·        headaches;
  • ·        backache;
  • ·        flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal.

How is genital herpes passed on?

Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:
  • ·        vaginal sex
  • ·        anal sex
  • ·        oral sex (HSV-1 or HSV-2)
  • ·        kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.

Testing for genital herpes

A herpes test will usually involve the following examinations, which are carried out by a doctor or nurse.

  • ·        A clinical examination will be done of a patient’s genital area.
  • ·        A sample will be taken, using a cotton wool or spongy swab, from any visible sores.
  • ·        Women may be given an internal pelvic examination (similar to a smear test).
  • ·        A sample of urine may be taken.

If the patient’s symptoms have already disappeared, or if there were no symptoms to begin with, a blood test can be taken to look for the virus. As in HIV testing, the herpes test works by searching for antibodies that the immune system produces to fight the virus. This means that the test is not effective until 3 months after exposure, as the body can take up to 3 months to produce an immune response.

It is possible to have more than one sexually transmitted infection at the same time, so it is advisable to have a full check-up.

Samples taken during an examination are sent to a laboratory for testing, and the result is usually available within 2 weeks, although this varies between countries.

Treatment for genital herpes

There is no cure for the herpes simplex virus and treatment is not essential, as an outbreak of genital herpes will usually clear up by itself. A doctor may however prescribe a course of antiviral tablets to reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.
Once the initial outbreak of herpes is over, the virus hides away in the nerve fibres adjacent to the infection site, where it remains dormant, causing no symptoms. It is possible for the dormant virus to be 'reactivated' in some people, in which case it travels back down the nerve to the skin surface.

Recurrences of genital herpes vary from person to person in frequency. Some will never experience an outbreak again, whilst others may have milder recurrences more than 6 times a year. Because these recurrent infections are milder, they often do not require treatment.

When receiving treatment for genital herpes, the doctor or health advisor will discuss the genital herpes infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with within a recent period, as they will also be at risk of having genital herpes and should be tested.

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