HIV and sexually transmitted disease (STD)

Genital Herpes

Genital herpes is caused by herpes simplex virus (HSV) type 1 and 2.

Oral herpes is usually caused by HSV-1 and can result in cold sores or blisters on or around the mouth. Most people do not have any symptoms. You can also get infected with HSV-1 during childhood from non-sexual contact with saliva. However, HSV-1 can spread from the mouth to the genitals through oral sex. That's why some cases of genital herpes are caused by HSV-1.

HSV-2 cause sores typically around the genital and anal region and almost exclusively transmitted through genital-to-genital contact during sexual activity. HSV-2 infection manifested by formation of tiny vesicles ("fluid- containing blisters") that then break open and result in formation of ulcers or sores. It typically heals between two to four weeks. Patient can sometime reported having tingling or shooting pain before the blisters appear.

There are two stages of genital herpes infection. Initial infection or primary genital herpes infection often cause more severe systemic symptoms in about 80% of people such as fever, malaise, body ache, swollen lymph nodes and headache. Formation of the vesicles close to the the urethra or penile opening can also cause difficulty urination and lead to urinary retention. The blisters can also cause burning pain and itchiness. It is important to keep the affected area clean and dry to prevent secondary bacterial infection. For an unknown reason, women tend to get more severe symptoms than men. 

After primary infection, the virus will enter period of latency where it remained dormant in the nerve cells. With reactivation, the virus travels from the nerve cells to the genitals region and may sometime cause minimal or no symptoms. However, there is still shedding of the virus occuring and risks of transmission to others.

Recurrence rates for HSV-2 varies depending on various factors. It can get reactivated spontaneously without any apparent reason but external factors such as being unwell with other infections, physical or emotional stress, being immunocompromised, damage to tissue (ie: shaving), expsoure to heat and cold, menstruation and sexual activity can potentially cause reactivation of the virus. About 90% of patient have recurrence during the first year and men get more recurrence than women. 

The most effective prevention of genital herpes is by avoidance of unprotected sexual activity. Use of condom decreases the risks of transmission. Currently there are no vaccine available to prevent from herpes infection. 

Diagnosis can be confirmed by serological testing by detection of antibodies to the virus. Oral anti-viral treatment such as Acyclovir and Valacyclovir are effective for treatment of genital herpes but it do not cure the disease. It can be used as an episodic or suppresive treatment. Side effects of the medication include nausea, vomiting, headache, and diarrhea. Patient with frequent recurrences will require suppresive therapy. It is recommended for patients with more than six episodes per year, but patient preferences will also need to be considered. Long-term safety and effectiveness have been well documented in patients receiving daily therapy of anti-viral treatment and has been shown to reduce the risk of transmission significantly to others.