Sexually Transmitted Diseases in Men - Genital Herpes

Do you have genital herpes? How did you catch it, and what were your symptoms?

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Genital herpes

What is genital herpes and how is it spread?

Genital herpes is a viral infection that causes clear blisters that overlie ulcers on the skin or mucosa (lining of the body's openings) of sexually exposed areas. Two types of herpes viruses are associated with genital lesions; herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). HSV-1 more often causes blisters of the mouth area while HSV-2 more often causes genital sores or lesions in the area around the anus (perianal region).

Most people infected with HSV-2 have not been diagnosed as being infected. If symptoms occur, they appear approximately 3 to 7 days after an initial exposure to herpes. Many men experience mild symptoms, which resolve spontaneously. Others can develop severe bouts of painful blisters on the penis that can be accompanied by fever and headache. Once a herpes infection occurs, it is life-long and can be characterized by recurrent sporadic outbreaks. The outbreaks occur because the dormant HSV is activated. Outbreaks occur at different rates in different individuals. The recurrences can be associated with stress or other infections. They also occur with increased frequency in those who have weakened immune systems, such as with HIV infection. These outbreaks usually are characterized by mildly to moderately painful clusters of blisters over the infected area. The recurrences usually resolve spontaneously, with the blisters disappearing in about 5 days. HSV in HIV-infected individuals, however, can cause more severe disease, which often causes ulcers rather than blisters and persists for a longer time.

Estimates are that as many as 50 million persons in the United States are infected with genital HSV. Genital herpes is spread only by direct person-to-person contact. Again, most infected people have not been diagnosed. Most genital herpes is passed on by people who do not have active signs of disease at the time of transmission.

How is herpes diagnosed?

The suspicion for genital herpes is usually based upon the appearance of multiple, painful clusters of small blisters over the penis or anal area. The definitive diagnosis is based on a culture of the virus. The culture is done by opening a blister, swabbing the base of the ulcer, and sending the swabbed material to the laboratory for culture.

Blood tests that detect antibodies to the HSV reveal whether someone is infected with herpes. These antibodies are proteins that are produced by the body in an immunological (defensive) response specifically targeted against this virus. The antibodies, however, do not indicate whether the person's current lesions are actually due to the herpes or another disease. The antibody test, therefore, is of minimal value in diagnosing genital herpes.

What should persons infected with genital herpes know?

Patients who are newly diagnosed with genital herpes should be aware that:

  • there is no cure for the infection,
  • recurrent episodes can occur, and
  • even when there are no obvious lesions, HSV can be spread to others.

Affected individuals should notify their sex partners that they are infected with HSV. They should avoid sexual activity not only when the blisters are present, but also when a pre-outbreak tingling, which sometimes is felt over the involved skin, occurs. Since HSV can be spread even during periods when there are no symptoms, condoms or other latex barriers should be used routinely during sexual contact with an infected person. This should be done even if the condoms are not needed at that time to prevent other STDs or to avoid pregnancy. Also, women with genital herpes should be aware of the possibility of that HSV can be spread to a newborn if the mother has an outbreak at the time of delivery. Finally, people with HSV infection should understand the clear, but limited role, of antiviral medications for the initial outbreak and for subsequent outbreaks and for suppressive therapy to prevent recurrences in patients with frequent outbreaks.

How is genital herpes treated?

Several antiviral drugs have been used to treat HSV infection, including acyclovir, famciclovir, and valacyclovir. Although topical (applied directly on the lesions) agents exist, they are generally less effective than other medications and are not routinely used. Medication that is taken by mouth, or in severe cases intravenously, is more effective. Affected individuals need to understand, however, that there is no cure for genital herpes and that these treatments only reduce the severity and duration of outbreaks.

Since the initial infection with HSV tends to be the most severe episode, an antiviral medication usually is warranted. These medications can significantly reduce pain and decrease the length of time until the sores heal, but treatment of the first infection does not appear to reduce the frequency of recurrent episodes.

In contrast to a new outbreak of genital herpes, recurrent herpes episodes tend to be mild, and the benefit of antiviral medications is only derived if therapy is started immediately prior to the outbreak or within the first 24 hours of the outbreak. Thus, the antiviral drug must be provided for the patient in advance. The patient is instructed to begin treatment as soon as the familiar pre-outbreak "tingling" sensation occurs or at the very onset of blister formation.

Finally, suppressive therapy to prevent frequent recurrences may be indicated for those with more than six outbreaks in a given year. Acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) may all be given as suppressive therapies.

What should a person do if exposed to someone with genital herpes?

People who have been exposed to someone with genital herpes should obtain counseling about herpes symptoms, the nature of the outbreaks, and how to prevent acquiring or transmitting herpes in the future. If the exposed person experiences an outbreak of herpes, he or she should be further evaluated to consider treatment.

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