Genital herpes
Specialty	Infectious diseases

Herpes genitalis (or genital herpes) refers to a genital infection by Herpes simplex virus, the most common sexually transmitted infection by the number of current cases. ^[1] Most individuals carrying herpes are unaware they have been infected and many will never suffer an outbreak, which involves blisters similar to cold sores.^{[2] [3]} While there is no cure for herpes, over time symptoms are increasingly mild and outbreaks are decreasingly frequent. ^[4][5]

Types

Genital herpes, or HSV, was classified into two distinct categories of HSV-1 and HSV-2 in the 1960s,^[4][5] and "HSV-2 was below the waist, HSV-1 was above the waist". ^{[citation needed]} Although genital herpes was previously caused primarily by HSV-2, genital HSV-1 infections are increasing and now cause up to 80% of infections.^[6] Genital HSV-1 infection recurs at rate of about one sixth of that of genital HSV-2.^[7] When symptomatic, the typical manifestation of a primary HSV-1 or HSV-2 genital infection is clusters of genital sores consisting of inflamed papules and vesicles on the outer surface of the genitals, resembling cold sores.^[8] These usually appear 4–7 days after sexual exposure to HSV for the first time.^[9]

Symptoms

Herpes is believed to be asymptomatic in the majority of cases, thus aiding contagion and hindering containment. ^{[citation needed]} In males, the lesions may occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions may appear on or near the pubis, labia, clitoris, vulva, buttocks or anus.^[8]

The mild effects of herpes cause the virus go without treatment and diagnosis. If individuals with herpes have symptoms, the symptoms are often mild, such as burning or itching that may last for a couple of days and goes away. In many cases, individuals either get misdiagnosed or they treat themselves. Although 80 percent of victims will have subsequent outbreaks, future episodes tend to be even milder than the first, causing many to ignore the symptoms and doctor consultation.^[10][11]

Other symptoms include pain, itching, and burning. There is no link between herpes and cancer. ^[12] Less frequent symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise.^[9] Women may experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal 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 the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash.^[13][14] Historically this has been termed Elsberg syndrome, although this entity is not clearly defined.^[13]

Epidemiology

More than one in five Americans have genital herpes ^[15] and 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 diseases.^[16] More than 80% of those infected are unaware of their diagnosis.^[17] Annually, 776,000 people in the United States get new herpes infections.^[17]

Tests for herpes are not routinely included among STD screenings. Performers in the pornography industry are 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. ^[18] Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not.^[19] New blood tests can distinguish between the two types of herpes though are known to report false positives and the CDC does not recommend screenings for all groups. ^{[20] [21]}

History

Early 20th century public health legislation in the United Kingdom required compulsory treatment for sexually transmitted diseases but did not include herpes because it was not serious enough.^[22] As late as the 1975, nursing textbooks did not include herpes as it was considered no worse than a common cold. After the development of acyclovir in the 1970s, the drug company Burroughs Wellcome launched an extensive marketing campaign that publicized the illness, including creating victim's support groups.^[22]

Treatment

As of June 2013^[update], genital herpes cannot be cured. Moreover, genital herpes can be transmitted by viral shedding prior to and following the visual signs of symptoms. There are however some drugs that can shorten outbreaks and make them less severe or even stop them from happening. Among these drugs are: acyclovir, valacyclovir and famciclovir.^[23]

Acyclovir is an antiviral drug used against herpes viruses, varicella-zoster, and Epstein-Barr Viruses. This drug 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 in capsules, tablets, suspension, injection, powder for injection, and ointment. The ointment is used topically and it decreases pain, reduces healing time, and limits the spread of the infection.^[24]

Valacyclovir is also used to treat herpes virus infections. Once in the body, it becomes the anti-herpes medicine, acyclovir. It helps relieve the pain and discomfort and the sores heal faster. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir.^[25]

Famciclovir is another antiviral drug that belongs to the same class of acyclovir and valacyclovir. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. This drug has a longer duration of action than acyclovir and it only comes in tablets.^[26]

See also

• Herpes simplex
• List of cutaneous conditions

References