Genital Herpes

February 8, 2017

Herpes is one of the most common sexually transmitted infections. It is caused by the herpes simplex virus (HSV). Genital herpes is usually spread by having vaginal, oral, or anal sex. One in five women ages 14 to 49 has genital herpes.

There are two types of HSV –

HSV-1 most often causes infections of the mouth and lips, called cold sores or “fever blisters.” Symptoms are often milder than genital herpes, and you may get fewer outbreaks.2 It can spread to the genital area during oral sex and cause genital herpes. If HSV-1 spreads to the genital area, it is still HSV-1.
HSV-2 is the most common cause of genital herpes. It is spread through vaginal, oral, or anal sex. HSV-2 can spread to the mouth during oral sex. If HSV-2 spreads to the mouth or lips during oral sex, it is still HSV-2.

Genital herpes is characterized by recurrent clusters of vesicles and lesions at the genital areas or below the waist. The female genital areas are on or near the pubis, vulva, labia, clitoris, buttocks or rectum. The areas for male genital herpes include on or around the penis, the inner thigh, buttocks, or rectum. Proctitis, or inflammation of the rectum, can be due to HSV.

The herpes simplex virus (HSV) is easily human transmissible. It is passed from one person to another by close, direct contact. The most common mode of transmission is through vaginal, anal or oral sex. When somebody becomes infected with HSV, it will generally remain dormant.

Most people who are infected with HSV do not know it because their symptoms are so slight – many people have no discernible symptoms.

Causes

HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to be broken or to have a sore.

Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection, but you can get herpes from kissing. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips – so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

The following can be ways of becoming infected –

Having unprotected vaginal or anal sex
Having oral sex with a person who gets cold sores
Sharing sex toys
Having genital contact with an infected person.

Infection of a baby can occur during vaginal delivery if the mother has genital herpes, particularly if it is the first attack. Babies infected in this way can become severely ill. The obstetrician and midwife should be told of past genital herpes infections so the risk of this complication can be minimised.

Risk Factors

People are at risk if they –

Are a woman – Women are more likely to have genital herpes than are men. The virus is sexually transmitted more easily from men to women than it is from women to men.

Have multiple sexual partners – Each additional sexual partner raises the risk of being exposed to the virus that causes genital herpes.

Symptoms

Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak most often happens within 2 days to 2 weeks of being infected.

General symptoms may include –

Decreased appetite
Fever
General sick feeling (malaise)
Muscle aches in the lower back, buttocks, thighs, or knees
Swollen and tender lymph nodes in the groin

Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. Areas where the sores may found include –

Outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks (in women)
Penis, scrotum, around the anus, on the thighs or buttocks (in men)
Tongue, mouth, eyes, gums, lips, fingers, and other parts of the body (in both genders)

Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear. When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.

Other symptoms may include-

Painful urination
Vaginal discharge (in women) or inability to empty the bladder that requires a urinary catheter

A second outbreak can appear weeks or months later. It is usually less severe and it goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.

Complications

Other sexually transmitted infections – Having genital sores increases the risk of transmitting or contracting other sexually transmitted infections, including AIDS.

Newborn infection – Babies born to infected mothers can be exposed to the virus during the birthing process. This may result in brain damage, blindness or death for the newborn.

Bladder problems – In some cases, the sores associated with genital herpes can cause inflammation around the tube that delivers urine from the bladder to the outside world (urethra). The swelling can close the urethra for several days, requiring the insertion of a catheter to drain the bladder.

Meningitis – In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord.

Rectal inflammation (proctitis) – Genital herpes can lead to inflammation of the lining of the rectum, particularly in men who have sex with men.

Treatment

Medications – Antiviral medication, such as acyclovir or valcyclovir, can lessen the severity of an outbreak, lower the chances of passing the virus to a partner and shorten the time it takes for a sore to heal. Medication works best if it is started as soon as possible after an outbreak begins.

As recurrent outbreaks are milder, treatment is not usually necessary.

Episodic treatment and suppressive treatment

Episodic treatment – This is generally for patients who have less than six recurrences in one year. A five-day course of antivirals is prescribed each time symptoms appear.
Suppressive treatment – If a patient has more than six recurrences in a year, or if symptoms are very severe, antiviral treatment may last longer. The aim here is to prevent further recurrences. Some patients may have to take acyclovir twice daily for several months. Although suppressive treatment significantly reduces the risk of passing HSV to a partner, there is still a risk.

Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby.

Tenofovir vaginal gel protects women from herpes simplex – tenofovir, an anti-HIV mediation, when formulated as a vaginal gel, was found to reduce herpes simplex infection risk, scientists from the USA, Belgium and Italy reported in the journal Cell Host & Microbe. They explained that when in the vaginal gel formulation, higher concentrations of the drug reach the vaginal cells compared to tenofovir’s orally administered equivalent.

To reduce the risk of developing or passing on genital herpes:

Use condoms when having sex – although condoms are recommended, they provide a “modest” reduction in the risk of acquiring HSV-2, compared to other STIs, researchers reported in Archives of Internal Medicine (July 13th, 2009 issue).
Do not have sex while symptoms are present (genital, anal, or skin-to-skin)
Do not kiss when there is a cold sore around the mouth
Do not have many sexual partners
Male circumcision cuts risk of genital herpes infection, as well as HPV

Some people find that stress, being tired, illness, friction against the skin, or sunbathing may trigger recurrences of symptoms. Avoiding such triggers, if they can be identified, may help reduce the number of recurrences.

Alternative Treatment

Many herbal and dietary supplement products claim to help fight herpes infection by boosting the immune system. There has been little research on these products, and little evidence to show that they really work. Some are capsules taken by mouth. Others come in the form of ointment that is applied to the skin. Popular herbal and supplement remedies for herpes simplex include –

Echinacea ( Echinacea purpurea )
Siberian ginseng ( Eleutherococcus senticosus )
Aloe ( Aloe vera )
Bee products that contain propolis, a tree resin collected by bees
Lysine
Zinc

Supplements

Lysine – Studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores. A few studies also suggest that lysine may help shorten the length of an outbreak. Lysine can increase the amount of calcium that the body absorbs.
Propolis – A resin made by bees, propolis is loaded with antioxidants that help fight infection and boost immune function. Studies show that, it can stop HSV-1 and HSV-2 from reproducing.
Zinc – Zinc is effective against HSV-1 and HSV-2. In one small study, people who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream.
Vitamin E – Topical application of vitamin E helps to relief pain and aid the healing of oral herpetic lesions.
Vitamin C – Ascorbic acid has been shown to inactivate a wide range of viruses in vitro, including Herpes simplex virus, and to enhance immune function.
Lithium – Preliminary evidence suggests that oral or topical lithium is beneficial. Lithium inhibited the replication of HSV-1 and HSV-2 in vitro at concentrations that did not inhibit host cell replication.

Herbs

Lemon balm – Several studies suggest that topical ointments containing lemon balm may help heal cold sores.
Aloe (Aloe vera) – Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men.
Rhubarb cream (Rheum palmatum) – A topical cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores.
Eleutherococcus or Siberian ginseng – Siberian ginseng reduced the frequency, severity, and duration of outbreaks. People with high blood pressure, certain heart conditions; diabetes; obstructive sleep apnea; hormone-related cancers such as breast cancer, ovarian cancer, or uterine cancer; narcolepsy (frequent day time sleeping); mania; or who are pregnant or breastfeeding should not take Siberian ginseng.
Peppermint oil (Mentha x piperita) – Peppermint oil helps to stop a number of viruses from reproducing, including herpes.
Tea Tree Oil – This substance has been hailed as a veritable cure-all when it comes to any ailment that involves open sores.
Samento extract – This substance is available in both pill and liquid form. It is extracted from a plant found in many rain forests around the world and is thought to be a major immune system booster. Most herpes outbreaks happen when the immune system is at a low point and the virus is able to cause an outbreak.

Mind Body Treatment

Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom a person wants to be intimate is also common. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. This may also include –

Relaxation Techniques
Self Hypnosis
Emotional Support

There are a number of natural options available for the prevention and treatment of Herpes simplex infections. These medications can be used to alleviate the symptoms of an outbreak and shorten its course or to suppress recurrences, reduce the number outbreaks and prevent spreading the disease.

Reference –

http://kidshealth.org/teen/sexual_health/stds/std_herpes.html

http://www.nhs.uk/conditions/genital-herpes/Pages/Introduction.aspx

http://www.womenshealth.gov/publications/our-publications/fact-sheet/genital-herpes.html

http://www.medicalnewstoday.com/articles/151739.php

http://patient.info/health/genital-herpes

http://smartsexresource.com/topics/herpes-simplex-virus

http://www.pamf.org/teen/sex/std/std/herpes.html

http://www.dermnetnz.org/viral/genital-herpes.html

http://www.fpa.org.uk/sexually-transmitted-infections-stis-help/genital-herpes

https://www.dred.com/uk/signs-of-genital-herpes.html

http://www.thebody.com/content/art6539.html