It is estimated that at least one in five adults is infected with the virus, but many of these have no symptoms and do not know they have the virus. Individuals who have genital herpes are encouraged to talk to a sexual partner, use condoms and take other measures to prevent transmission. Genital herpes can be transmitted even when there are no visible sores or blisters.
Genital herpes is an infection caused by herpes simplex virus type 2, which is transmitted through sexual intercourse. The herpes simplex virus type 1 can cause genital herpes as well, but is usually associated with herpes labialis.
Herpes simplex virus type 2 is transmitted through sexual contact, being highly contagious when the patient has active lesions (the symptoms will be explained below). A big problem is that genital herpes transmission can occur even in times when the patient is asymptomatic. Therefore, even when the virus is eliminated intermittently, the patient can transmit genital herpes to your partner(s). Usually in a period of 100 days, the patient has 2 or 3 times of eliminating the virus asymptomatically.
The frequency of virus shedding is becoming smaller as the years pass from the first appearance of herpes. The disposal out of the crisis is greatest in the first three months after primary infection. After 10 years of infection, the transmission out of the crisis is becoming increasingly less common. 400 patients with genital herpes were studied for more than 10 years and sampled out of the genitals of seizures for a period of 30 days. Only 9% had detectable virus in this range for transmission.
Herpes simplex virus
Whenever the patient has a crisis, its transmission rate rises again, going back to last fall as the crisis is getting older. 70% of transmissions of genital herpes occur in the asymptomatic phase, since during the crises the patient usually avoids having sex.
HIV-positive patients who also have genital herpes are the group with the highest transmission possibility during the asymptomatic phase.
The herpes simplex virus type 1 often causes lesions only in the mouth, but can be transmitted to the genitals during oral sex. Once infected, patients with type 1 herpes can transmit the disease in the same way that patients infected with the second type. The difference is that crises are usually milder and less frequent, and the transmission out of the crisis is less common.
The herpes simplex virus type 2 survives for a very little time in the environment, transmission through clothing or towels is uncommon. You cannot get genital herpes in swimming pools or toilets.
The use of condoms reduces the chance of transmission, but does not eliminate it completely, since the herpes lesions can appear in the genital areas that are not covered by the condom. For example, a herpes lesion on the scrotum remains exposed even with the proper use of condoms.
Most patients who become infected with herpes simplex virus type 2 do not develop the disease, remaining asymptomatic and unaware of the infection. Studies suggest that up to 80% of infected patients do not develop symptoms. In patients who develop symptoms, the clinical picture is divided into two situations: primary infection and recurrence.
Primary infection of genital herpes
Herpes infection
The first time that the lesions of genital herpes occur after the patient has been infected is called the primary infection.
The symptoms of genital herpes tend to develop in three to seven days after intercourse responsible for the infection, but in some cases may take up to two weeks. The main sign of genital herpes are small grouped blisters on the genitals. Typically, the bubbles appear and then immediately break to form ulcers. In primary infection these lesions tend to be very painful. The infected area can also itch.
Besides the typical lesions of herpes, primary infection is usually accompanied with other symptoms such as fever, malaise and body ache. They can arise in lymph nodes groin area, and if the ulcers are close to the urethra, there may be intense pain while urinating.
In men genital herpes sores usually appear on the penis or near it. In women lesions may be visible outside the vagina, but they usually occur inside, where they are hidden. In the chaos of internal injuries, the only signs of disease may be vaginal discharge and / or discomfort during intercourse. The lesions of genital herpes can also arise at any point of the perineum and around the anus of the patient who practice anal sex.
The lesions in primary infection of genital herpes usually take on average 20 days to disappear.
Recurrences of genital herpes
Herpes recurrences
After primary infection genital herpes lesions disappear remaining silent for several months. In most patients the infection emerges from time to time, in some cases, more than once a year. 90% of patients experience a recurrence in the first interval of 18 months after primary infection. Some may have more than 10 recurrences within a year. Patients usually having frequent recurrences are those who have a prolonged primary infection with herpes initial lesions lasting more than one month.
The recurrent lesions tend to be less painful and last for about 10 days, half the time of primary infection. It is common to have other symptoms such as malaise and fever. Over the years recurrences are becoming weaker and less frequent.
Recurrences of genital herpes usually appear after a stressful event for the body. Among the most common are extreme physical exertion, emotional stress, illness, recent surgery, excessive sun exposure and immunosuppression. In some women the period may be the trigger. However, there are cases in which recurrence is not possible to identify any triggering factor.
Days before the lesions recur, the patient may experience some symptoms of warning, like an itchy labia majora, a penile numbness or tingling in the genital region. Many patients can identify a recurrence of genital herpes to be on the way.
In some cases the patient may not develop symptoms of primary infection soon after infection, ulcers can appear only years later, after some event that reduces your immunity. In these cases, in spite of the first appearance of the wounds, the disease behaves more like a recurrence than as primary infection, being shorter and less painful. Nor are common symptoms such as fever and malaise. The problem is that, as the first appearance of the wound, the patient tends to think he has been infected recently, and this often causes problems in couples with a stable relationship for years. In these situations it is very difficult to establish precisely when the patient was infected and whoor what was the cause.
The lesions of genital herpes are typical during the crisis and are easily recognized by experienced physicians. If there is need for laboratory confirmation, or if the damage is not very typical, the doctor may take samples of ulcers for virus identification. In asymptomatic phases it is possible to investigate the herpes infection through serology, which can identify both the herpes simplex virus type 1 and type 2. The blood tests are also important for the screening of partners of infected patients.
The tests can identify the virus, but do not provide information on when the patient was infected.
Although there is no cure for genital herpes, infection can be controlled with antiviral therapy. The antiviral treatment serves to accelerate the healing of injuries, alleviate the symptoms to prevent complications and reduce the risk of transmission to others.
Three antiviral drugs are used for the treatment of genital herpes: Acyclovir (Zovirax), Famciclovir (Famvir), Valacyclovir (Valtrex).
The first genital herpes episode is usually treated for 7 to 10 days orally. If no improvement of ulcers is observed, treatment may be extended for another week. Treatment works best if started within 72 hours after appearance of the symptoms.
In recurrences the handling can be done by only 5 days. People with a history of recurrent genital herpes are often advised to keep a stock of antiviral medication at home, in order to start treatment as soon as the first signs of a recurrence.
If the patient presents with rare recurrences and causes few symptoms, there may be no need for treatment with antivirals, especially if he/she does not have a sex partner(s) at the time that can be infected.
In patients with more than six outbreaks per year can be indicated suppressive therapy, which consists of continuous daily use of an antiviral at low doses to avoid recurrences. The advantage of suppressive therapy is that it reduces the frequency and duration of relapse, and can also reduce the risk of transmission of herpes virus to the uninfected partner.
It is unclear how long the suppressive therapy should be maintained. Some experts recommend pause treatment periodically (every few years) to determine if the suppressive therapy is still required. If outbreaks return, suppressive therapy can be resumed.
The suppressive therapy may be indicated also in cases of sexual partners with discordant serology, i.e., one infected with herpes and the other is not. The suppressive therapy reduces the risk of transmissionby more than 50%. When associated with condom use, the risk of transmission of genital herpes is smaller.
In addition to the antiviral drugs, certain home therapy can be used to alleviate the symptoms of an outbreak of genital herpes. Sit in bath with cold water can temporarily decrease the pain of the wounds. Women who are having pain urinating may feel less discomfort during the sitz bath or a shower with warm water. Soaps and bubble baths should be avoided. It is also important to keep the genital area clean and dry and avoid tight underwear. Creams and ointments are generally not recommended. If the pain is very uncomfortable, analgesics or anti-inflammatory drugs may be used.
I would like to know what will happen if a woman, that has genital herpes, gets pregnant. Can she give birth to a healthy baby? Or does the disease prevent women from getting pregnant?
