Wikipedia

Genital herpes

Genital herpesis aherpesinfection of thegenitalscaused by theherpes 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 smallblistersthat break open to form painfululcers.[1]Flu-like symptoms,such as fever, aching, or swollenlymph 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]

Genital herpes
Other namesAnogenital herpesviral infection, herpes genitalis
An outbreak of genital herpes affecting thevulva
SpecialtyInfectious disease
SymptomsNone,small blistersthat break open to form painfululcers,flu-like symptoms[1][2]
ComplicationsAseptic meningitis,increased risk ofHIV/AIDSif exposed,neonatal herpes[1]
Usual onset2–12 days after exposure[1]
DurationUp to 4 weeks (first outbreak)[1]
CausesHerpes simplex virus(HSV-1, HSV-2)[1]
Diagnostic methodTesting lesions,blood testsforantigen[1]
Differential diagnosisSyphilis,chancroid,molluscum contagiosum,hidradenitis suppurativa[3]
PreventionNot having sex, usingcondoms,only having sex with someone who is not infected[2]
TreatmentAntiviral medication[1]
Frequency846 million (2015)[4]

The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected.[1]This may occur duringsex,includinganal,oral,andmanual 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 thedeveloped world.[1][7]Diagnosis may occur by testing lesions using eitherPCRorviral cultureorblood testsfor specificantibodies.[1]

Efforts to prevent infection includenot having sex,usingcondoms,and only having sex with someone who is not infected.[2]Once infected, there is no cure.[2]Antiviral medicationsmay, 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 includeaseptic meningitis,an increased risk ofHIV/AIDSif exposed toHIV-positiveindividuals, and spread to the baby duringchildbirthresulting inneonatal herpes.[1]

Signs and symptoms

Genital herpes affecting thepenis

In males, the lesions occur on theglans penis,shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, oranus.In females, lesions appear on or near thepubis,clitorisor other parts of thevulva,buttocks or anus.[2]

Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis orvagina,fever,headache,muscle pain (myalgia), swollen and enlarged lymph nodes andmalaise.[9]Women often experience additional symptoms that include painful urination (dysuria) andcervicitis.Herpeticproctitis(inflammation of the anus and rectum) is common for individuals participating inanal 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 thesacralregion of thespinal cordcan cause acuteurinary retentionand one-sided symptoms and signs of myeloradiculitis (a combination ofmyelitisandradiculitis): 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 byHSV-2,there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused byHSV-1is 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 withsuppressive 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 byviral sheddingprior 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 externalcondomuse by 50%, byinternal condomby 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, externalcondomsfor the penis may be used duringoral sex,vaginal sex,andanal 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 damsmay 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 suppressiveantiviraldrugs.[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 aphysical examinationby a doctor or through a herpes simplex virus (HSV) test by sampling fluid within a genitalblisteror blood for HSVantibodies.[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 forasymptomaticscreening for genital herpes.[8]

False negativetest 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 highfalse-positivityrate.[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 duringdelivery.In the United States, 20-25% of pregnant women have genital herpes; however, fewer than 0.1% of babies born getneonatal herpesduring 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, aCesarean sectionis the safest method of preventing contact and transmission of herpes simplex virus between the mother and the baby.[19]Alternatively, some physicians use the drugacyclovirto 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 medicationsprovide 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 anantiviral medicationand 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 incapsules,tablets,andointment.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 aprodrugthat is converted to penciclovir in thebody.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 takeover-the-counterpain relief medication such asibuprofenoracetaminophen.[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 thepornography industryare 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]Mostsex workersand 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 ofacyclovirin the 1970s, the drug companyBurroughs Wellcomelaunched an extensive marketing campaign that publicized the illness, including creating victim's support groups.[30]

Research

Main article:Herpes simplex research

There are efforts to develop avaccinefor 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]

References

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  2. ^abcdef"STD Facts – Genital Herpes".2017-12-11.Retrieved30 October2018.
  3. ^Ferri FF (2010).Ferri's Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders.Elsevier Health Sciences. p. 230.ISBN978-0323076999.
  4. ^ab"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015".Lancet.388(10053):1545–1602. 8 October 2016.doi:10.1016/S0140-6736(16)31678-6.PMC5055577.PMID27733282.
  5. ^Hoyle A, McGeeney E (2019).Great Relationships and Sex Education.Taylor and Francis.ISBN978-1-35118-825-8.RetrievedJuly 11,2023.
  6. ^abcdefGenital herpes: How can you prevent the spread of herpes in sexual relationships?.December 12, 2012.
  7. ^Beigi RH, ed. (2012-03-27).Sexually transmitted diseases.Chichester, West Sussex: John Wiley & Sons, Ltd. p. 139.ISBN9781118314975.
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  9. ^abcGupta R, Warren T, Wald A (December 2007). "Genital herpes".Lancet.370(9605):2127–37.doi:10.1016/S0140-6736(07)61908-4.PMID18156035.S2CID40916450.
  10. ^abSakakibara R, Yamanishi T, Uchiyama T, Hattori T (August 2006). "Acute urinary retention due to benign inflammatory nervous diseases".Journal of Neurology.253(8):1103–10.doi:10.1007/s00415-006-0189-9.PMID16680560.S2CID24474530.
  11. ^Vonk P (December 1993). "[Elsberg syndrome: acute urinary retention following a viral infection]".Nederlands Tijdschrift voor Geneeskunde(in Dutch).137(50):2603–5.PMID8277988.
  12. ^abHow the facts about Genital Herpes can help.By New Zealand Herpes Foundation. Retrieved June 2014
  13. ^abLe Cleach L, Trinquart L, Do G, Maruani A, Lebrun-Vignes B, Ravaud P, Chosidow O (August 2014)."Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients".The Cochrane Database of Systematic Reviews.2014(8): CD009036.doi:10.1002/14651858.CD009036.pub2.PMC11022119.PMID25086573.
  14. ^ab2007 National Guideline for the Management of Genital Herpes.Archived2015-09-23 at theWayback MachineBy Clinical Effectiveness Group at British Association for Sexual Health and HIV.
  15. ^abcd"Sexually transmitted diseases (STDs) - Symptoms and causes".Mayo Clinic.Retrieved2022-09-18.
  16. ^"Genital herpes | Office on Women's Health".www.womenshealth.gov.Retrieved2022-09-16.
  17. ^abcdef"Genital Herpes".www.hopkinsmedicine.org.2021-08-08.Retrieved2022-09-16.
  18. ^abBibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng CW (December 2016)."Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement".JAMA.316(23):2525–2530.doi:10.1001/jama.2016.16776.PMID27997659.
  19. ^abcde"Herpes & Pregnancy – American Sexual Health Association".www.ashasexualhealth.org.4 September 2014.Retrieved2022-09-18.
  20. ^abcdeWorkowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA (2021-07-23)."Sexually Transmitted Infections Treatment Guidelines, 2021".MMWR. Recommendations and Reports.70(4):1–187.doi:10.15585/mmwr.rr7004a1.ISSN1057-5987.PMC8344968.PMID34292926.
  21. ^"Brand Name: Valtrex".Retrieved30 October2018.
  22. ^"Brand Name: Famvir".Retrieved30 October2018.
  23. ^Diaz-Mitoma F (1998-09-09)."Oral Famciclovir for the Suppression of Recurrent Genital HerpesA Randomized Controlled Trial".JAMA.280(10):887–892.doi:10.1001/jama.280.10.887.ISSN0098-7484.PMID9739972.S2CID31772442.
  24. ^Mertz GJ (1997-02-10)."Oral Famciclovir for Suppression of Recurrent Genital Herpes Simplex Virus Infection in Women: A Multicenter, Double-Blind, Placebo-Controlled Trial".Archives of Internal Medicine.157(3): 343.doi:10.1001/archinte.1997.00440240109016.ISSN0003-9926.
  25. ^Corey L, Wald A, Patel R, Sacks SL, Tyring SK, Warren T, Douglas JM, Paavonen J, Morrow RA, Beutner KR, Stratchounsky LS, Mertz G, Keene ON, Watson HA, Tait D (January 2004)."Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes".New England Journal of Medicine.350(1):11–20.doi:10.1056/NEJMoa035144.ISSN0028-4793.PMID14702423.
  26. ^Allen J (2010-03-09)."U.S. herpes rates remain high - CDC".Reuters.Retrieved2013-05-03.
  27. ^ab"Genital Herpes - CDC Fact Sheet".Retrieved2013-06-03.
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  29. ^"Sore Subject: The Symptoms of Herpes Aren't Just Physical".2012-01-09.Retrieved2013-11-04.
  30. ^abcScott N (1 September 2011)."The courts should keep out of our sex lives".Spiked.Retrieved30 October2018.
  31. ^Hofstetter AM, Rosenthal SL, Stanberry LR (February 2014). "Current thinking on genital herpes".Current Opinion in Infectious Diseases.27(1):75–83.doi:10.1097/qco.0000000000000029.PMID24335720.S2CID4910110.
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