Genital herpes

Genital herpes
Synonyms Anogenital herpesviral infection, herpes genitalis
A case of genital herpes affecting the external vagina.
Specialty Infectious disease
Symptoms None, small blisters that break open to form painful ulcers, flu-like symptoms[1][2]
Complications Aseptic meningitis, increased risk of HIV/AIDS, neonatal herpes[1]
Usual onset 2-12 days after exposure[1]
Duration Up to 4 weeks (first outbreak)[1]
Causes Herpes simplex virus (HSV-1, HSV-2)[1]
Diagnostic method Testing lesions, blood tests[1]
Differential diagnosis Syphilis, chancroid, molluscum contagiosum, hidradenitis suppurativa[3]
Prevention Not having sex, using condoms, only having sex with someone who is not infected[2]
Treatment Antiviral medication[1]
Frequency 846 million (2015)[4]

Genital herpes is an infection by herpes simplex virus (HSV) of the genitals.[1] Most people either have no or mild symptoms and thus do not know they are infected.[1] When symptoms do occur, they typically include small blisters that break open to form painful ulcers.[1] Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur.[2] Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks.[1] Once infected further outbreaks may occur but are generally milder.[1]

The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected.[1] This may occur during sex, including anal and oral sex.[1] Sores are not required for transmission to occur.[1] The risk of spread between a couple is about 7.5% over a year.[5] HSV is classified into two types, HSV-1 and HSV-2.[1] While historically mostly cause by HSV-2, genital HSV-1 has become more common in the developed world.[1][6] Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies.[1]

Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected.[2] Once infected, there is no cure.[2] Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur.[1] The long term use of antivirals may also decrease the risk of further spread.[1]

In 2015 about 846 million people (12%) had genital herpes.[4] In the United States, more than one-in-six people have HSV-2.[7] Women are more commonly infected than men.[1] Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010.[1] Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed, and spread to the baby during childbirth resulting in neonatal herpes.[1]

Signs and symptoms

Genital herpes affecting the penis

In males, the lesions 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 appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus.[2]

Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise.[8] Women often 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.[8]

After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts.[8] 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.[9][10] Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined.[9]

Recurrence

After a first episode of herpes genitalis caused by HSV-2, there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%.[11] Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year.[11]

People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir.[12] Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor.[12] People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy.[13] Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency.[13]

Transmission

Genital herpes can be spread by viral shedding prior to and following the formation of ulcers. The risk of spread between a couple is about 7.5% over a year (for unprotected sex).[5] The likelihood of transferring genital herpes from one person to another is decreased by male condom use by 50%, by female condom by 50%, and refraining from sex during an active outbreak.[5] The longer a partner has had the infection, the lower the transmission rate.[5] An infected person may further decrease transmission risks by maintaining a daily dose of antiviral medications.[5] Infection by genital herpes occurs in about 1 in every 1,000 sexual acts.[5]

Screening

Testing peoples' blood, including those who are pregnant, who do not have symptoms for HSV is not recommended.[14] This is due to concerns of greater harm than benefit, as there is a high false-positive rate and receiving a positive test result can cause other problems, such as relationship difficulties.[14]

Treatment

As of May 2018, genital herpes cannot be cured. There are, however, some medications that can shorten outbreaks including acyclovir, valacyclovir, and famciclovir.

Acyclovir is an antiviral medication and 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.[15]

Valacyclovir is a prodrug that is converted to acyclovir once in the body. It helps relieve the pain and discomfort and speeds healing of sores. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir.[16] An example usage is by mouth twice per day for ten days for primary lesion, and twice per day for three days for a recurrent episode.[17]

Famciclovir is another antiviral drug that belongs to the same class. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. It has a longer duration of action than acyclovir and it only comes in tablets.[18]

Epidemiology

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.[19] More than 80% of those infected are unaware of their infection.[20] Annually, 776,000 people in the United States get new herpes infections.[20]

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.[21] Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not.[22]

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.[23] As late as 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.[23]

Research

There are efforts to develop a vaccine, but the results so far have not been able to cure herpes or eliminate transmission.[24]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 "Genital Herpes – CDC Fact Sheet". 9 February 2017. Retrieved 20 December 2017.
  2. 1 2 3 4 5 6 "STD Facts – Genital Herpes". Retrieved 2017-12-20.
  3. ↑ Ferri, Fred F. (2010). Ferri's Differential Diagnosis: A Practical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders. Elsevier Health Sciences. p. 230. ISBN 0323076998.
  4. 1 2 GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  5. 1 2 3 4 5 6 pmhdev (December 12, 2012). "Genital herpes: How can you prevent the spread of herpes in sexual relationships?". PubMed Health.
  6. ↑ Beigi, Richard H., ed. (2012-03-27). Sexually transmitted diseases. Chichester, West Sussex: John Wiley & Sons, Ltd. p. 139. ISBN 9781118314975.
  7. ↑ "STD Facts - Genital Herpes". www.cdc.gov. December 11, 2017. Retrieved September 22, 2018. Genital herpes is common in the United States. More than one out of every six people aged 14 to 49 years have genital herpes.
  8. 1 2 3 Gupta R, Warren T, Wald A (December 2007). "Genital herpes". Lancet. 370 (9605): 2127–37. doi:10.1016/S0140-6736(07)61908-4. PMID 18156035.
  9. 1 2 Sakakibara R, Yamanishi T, Uchiyama T, Hattori T (August 2006). "Acute urinary retention due to benign inflammatory nervous diseases". Journal of Neurology. 253 (8): 1103–10. doi:10.1007/s00415-006-0189-9. PMID 16680560.
  10. ↑ Vonk P (December 1993). "[Elsberg syndrome: acute urinary retention following a viral infection]". Nederlands Tijdschrift Voor Geneeskunde (in Dutch and Flemish). 137 (50): 2603–5. PMID 8277988.
  11. 1 2 How the facts about Genital Herpes can help. By New Zealand Herpes Foundation. Retrieved June 2014
  12. 1 2 Le Cleach L, Trinquart L, Do G, Maruani A, Lebrun-Vignes B, Ravaud P, Chosidow O (August 2014). "Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients". The Cochrane Database of Systematic Reviews. 8 (8): CD009036. doi:10.1002/14651858.CD009036.pub2. PMID 25086573.
  13. 1 2 2007 National Guideline for the Management of Genital Herpes. By Clinical Effectiveness Group at British Association for Sexual Health and HIV.
  14. 1 2 Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, et al. (December 2016). "Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement". Jama. 316 (23): 2525–2530. doi:10.1001/jama.2016.16776. PMID 27997659.
  15. ↑ "Medications and Drugs". Retrieved 2010-05-03.
  16. ↑ "Brand Name: Valtrex". Retrieved 2010-05-03.
  17. ↑ Canadian Guidelines on Sexually Transmitted Infections > Section 5 - Management and Treatment of Specific Infections > Genital Herpes simplex virus (HSV) Infections. from the Public Health Agency of Canada. Date Modified: 2013-02-01.
  18. ↑ "Brand Name: Famvir". Retrieved 2010-05-03.
  19. ↑ Allen J (2010-03-09). "U.S. herpes rates remain high - CDC". Reuters. Retrieved 2013-05-03.
  20. 1 2 "Genital Herpes - CDC Fact Sheet". Retrieved 2013-06-03.
  21. ↑ "Prevent STDs like a porn star". CNN. 2011-05-19. Retrieved 2013-11-04.
  22. ↑ "Sore Subject: The Symptoms of Herpes Aren't Just Physical". Retrieved 2013-11-04.
  23. 1 2 "The courts should keep out of our sex lives". Retrieved 2013-06-13.
  24. ↑ Hofstetter AM, Rosenthal SL, Stanberry LR (February 2014). "Current thinking on genital herpes". Current Opinion in Infectious Diseases. 27 (1): 75–83. doi:10.1097/qco.0000000000000029. PMID 24335720.
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