simplex virus 1 (HSV-1), which causes cold sores,
may also cause sores in the genital area. Genital
herpes is one of the most prevalent STDs in the
United States, infecting about 25 percent of teens
and adults—more than 45 million people. About 1
million new infections occur each year.
As is characteristic of the herpesviruses, HSV-2
remains in the body for life after the initial infec-
tion, retreating to NERVEroots within the areas of
infection. Periodically the virus travels along the
nerves to the surface of the SKIN, causing out-
breaks of blisters that become crusted sores. Dur-
ing these outbreaks the virus both replicates and
sheds, and the infected person is highly conta-
gious. Such a pattern of REMISSIONand RECURRENCE
continues through life; there currently is no cure
for genital herpes.
Direct contact with SEMEN, vaginal fluids, and
saliva spreads genital herpes from one person to
another during vaginal intercourse, anal inter-
course, or oral sex. The infection does not spread
via contact with objects such as toilet seats or in
water (such as swimming pools and hot tubs).
Genital herpes is contagious even when no sores
are present. Because symptoms may be mild, or in
women occur within the VAGINA, many people do
not know they have genital herpes. The first out-
break of symptoms tends to be the most severe.
Over time outbreaks tend to become less frequent
with fewer and smaller sores.
Symptoms and Diagnostic PathSymptoms, when they occur, begin about two
weeks after sexual contact with an infected person
who is shedding the virus. Initial symptoms may
include
- tingling, burning, or pain at the site of infection
(PENIS, vagina, CERVIX, ANUS, RECTUM,MOUTH, and
sometimes on skin surfaces) - FEVER
- HEADACHE
- swollen LY M P Hnodes near the site of the infec-
tion - vaginal discharge in women
- painful URINATIONin men
The hallmark symptom of genital herpes is
painful sores that begin as red bumps that BLISTER
and then crust. The sores appear at the sites where
the virus entered the body and are usually most
severe with the first outbreak. Symptoms of sub-
sequent outbreaks tend to be more mild, though
sores may appear in new locations as the virus
spreads along nerve paths. The sores are present
for three to four weeks and then heal without
scarring. Periods of remission during which there
are no sores or other symptoms may last several
weeks to several months.
Health-care providers generally presume a
diagnosis of genital herpes when the characteristic
sores are present in a person who is sexually
active. BLOODtests can detect the presence of HSV
antibodies but this is not especially useful infor-
mation from a diagnostic perspective because
more than 90 percent of people have some sort of
herpesvirus infection—herpes simplex, HERPES
ZOSTER, varicella (CHICKENPOX)—that activates the
ANTIBODYresponse and blood tests cannot distin-
guish among the type of herpesvirus present. Cul-
tures of the sores may produce HSV-2, which
confirms the diagnosis. However, cultures of the
sores may sometimes be negative even when HSV-
2 infection is present.Treatment Options and Outlook
The sores that erupt during a genital herpes out-
break will heal without treatment within two or
three weeks. ANTIVIRAL MEDICATIONScan shorten
the length of the outbreak and reduce the number
and severity of the sores. Some people benefit
from taking an antiviral medication daily, which
may lessen the frequency of outbreaks. Valacy-
clovir is the medication doctors most commonly
prescribe for regular use. Antiviral medications do
not cure genital herpes, however.ANTIVIRAL MEDICATIONS TO TREAT GENITAL HERPES
acyclovir famciclovir valacyclovirMost people who have genital herpes experi-
ence outbreaks of symptoms several times a year.
Stress, MENSTRUATION, and other viral infections
such as COLDSseem to trigger outbreaks though
symptoms may erupt without apparent cause. The
open sores of genital herpes create increased risk
for infection with HIV. A pregnant woman can
pass genital herpes to her unborn child; doctors328 Infectious Diseases