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Herpes The Gift that Keeps on Giving

Herpes can affect the mouth region or the genital area. This bothersome condition is the gift that keeps on giving. If you are concerned about herpes, find out about the symptoms, complications, prevention and treatment of this viral infection.


Is there more than one kind of herpes?


The first thing to know about herpes is that there are two related - but different - afflictions:  the oral type, which is cold sores or fever blisters, and the genital type. Both are caused by either one of two distinct - but related - viruses:  herpes simplex virus type-1 (HSV-1) or herpes simplex virus type-2 (HSV-2). 
Oral herpes- The hallmark of oral herpes is the presence of cold sores or fever blisters. These sores - as anyone who has had one can tell you - are small but painful, fluid-filled blisters that appear on the lips, mouth, throat, nose or chin. While oral herpes can be caused by either HSV-1 or HSV-2, most all cases are a result of HSV-1 (Herpes.com, 2011).


Genital herpes- This type of herpes is a sexually transmitted disease (STD), to which there is no known cure. Once acquired, the infection stays in your body, residing within certain nerve cells. While genital herpes is generally caused by HSV-2 acquired through sexual contact with an infected person, HSV-1 infections of the genitals also occur. Genital HSV-1 outbreaks recur less frequently than genital HSV-2 outbreaks and are generally less severe (Herpes.com, 2013).


Oral Versus Genital Herpes


Oral herpes - Primary herpes simplex is a term used to describe the first time that an individual shows signs of oral herpes. Typically, the primary lesions are seen in the vicinity of your mouth. In some cases, they may be accompanied with inflammation, fever and lymph node swelling. For many people, these sores resolve within 14 days as the virus migrates to nerve cells were it remains in a latent phase. Nonetheless, the virus can be reactivated by a number of stressful factors such as sunburn, respiratory tract infection, fever or anxiety (Encylopedia Brittanica, 2013).


Genital herpes - This type of herpes is most always caused by infection with HSV-2. HSV-2 is highly contagious and is most usually transmitted through direct genital-genital contact. There is a certain stealth element to genital herpes, in that it can be transmitted by infected individuals who are asymptomatic, and may not even yet know that they are infected. This means you can catch it from someone who does not have visible open sores (Encylopedia Brittanica, 2013).


What are the symptoms of genital herpes?


The period of time between infection and manifestation of symptoms could range from one day to two weeks, with an average time to onset of 4-5 days. The first symptom you notice is pain or itching followed shortly thereafter by single or groups of blisters. Men are usually infected on their penis, while women are afflicted throughout the vaginal region and sometimes the cervix.  After an additional few days, the blisters break, and large patches of swollen and inflamed skin appears.  This can be extremely painful and be accompanied by intense burning.


In females, urination may also cause great discomfort when herpes are present. General symptoms of fever and malaise are common and lymph nodes in the groin area may become enlarged. This state can continue for a week or longer, followed by complete healing in 4-6 weeks. Genital herpes is typically more severe in females and may even require hospitalization in some cases.  Recurrences are common and may be associated with stressful situations.  Recurrent episodes may be less severe than the initial infection (Encylopedia Brittanica, 2013).


Quick Herpes Facts


• Oral herpes is quite common:  it has been estimated that 80% of the population has been exposed to HSV-1 (Herpes.com, 2013).


• Genital HSV-2 infection is more common in women than men:  approximately 1 in 4 women have genital herpes compared to 1 in 8 men. Although not proven, it is hypothesized that this may be a result of an increased likelihood of male-to-female transmission (Herpes.com, 2013).


• It is possible for women to transmit the HSV-2 virus to their offspring during childbirth: Genital herpes can lead to serious infections, to include those of the central nervous system.  This is a very critical situation, as HSV-2 infection is fatal in 60% of newborns and causes mental retardation in 20% of those who survive.  As a result, cesarean section is usually suggested in near term women with active HSV-2 infection.
 (Encyclopedia Brittanica, 2013)


Will I give herpes to my partner?


Herpes researchers Mertz and colleagues studied a total of 144 heterosexual couples that had one partner with symptomatic, recurrent genital herpes. Each susceptible partner did not have genital herpes, however. The couples were followed for nearly one year so the researchers could determine how many of the susceptible partners would contract genital herpes. Transmission of genital herpes was observed in almost 10% of the couples. The investigators described a male-to-female transmission in 17% of the 65 couples with male source partners, and a transmission rate of 4% in the 79 couples with a female source partner. In 9 of the couples, transmission occurred when the source partner was asymptomatic. So, even in the case where couples are aware of the presence of genital herpes, substantial risk of transmission still exists. Interestingly, previous HSV-1 infection appears to have reduced the risk of acquiring HSV-2 among the women studied.


What are the complications of herpes?


Although not proven, HSV-2 infections have been implicated with later development of cervical cancer. Herpes experts Corey and colleagues reported the following complications observed in their study of 630 men and women with genital herpes:


• Aseptic meningitis (inflammation of the brain tissue without active infection)

• Lesions on the body other than on the genitals

• Yeast infections

(Encyclopedia Brittanica, 2013)


Treatment Options


Unfortunatley, for oral herpes, there is no way to cure an HSV-1 infection. Although antiviral treatment with acyclovir (Zovirax) or valacyclovir (Valtrex) very early in the outbreak of the disease may shorten its duration, it does not completely eliminate the pathogen. As long as the virus remains somewhere in the body in a latent form, antiviral drugs are not able to totally eradicate the infection. Like oral herpes, antiviral agents can shorten the duration of a genital herpes outbreak along with decreasing the time that the virus is contagious. During the latency period, the virus is immune against destruction. For patients with frequent recurrences, daily low-dose antiviral therapy helps to decrease the incidence of outbreaks. A variety of topical agents such as camphor, alcohol, ointments and antiseptics may lessen the discomfort associated with both types of herpes (Encyclopedia Brittanica, 2013).


Prevention is better than treatment, however. Everyone should work to reduce the risk of HSV infection by reducing their number of sexual partners and using condoms. Open herpes sores should be avoided by un-infected people. The risk of men contracting genital herpes may be reduced through circumcision (Encyclopedia Brittanica, 2013).


A Cure may be on the Way


Researchers are developing agents that prevent the virus from creating the microRNA necessary to keep HSV-1 in a latent state. If these agents pass clinical trials, they would cause the virus to remain in an active state and then be susceptible to existing antiviral agents. This would cure the disease completely. A German company is in late stage testing of a new class of drugs called helicase-primase inhibitors. The mechanism of these drugs is unique from existing drugs, and they have the promise to revolutionize the treatment of people with genital herpes. An online petition is available asking Congress to compel FDA to fast track the approval of this new medicine at:http://www.petition2congress.com/4807/fda-fast-track-aic-316-hsv2-therapeutic-drug/ 

References


Corey L, Adams HG, Brown ZA. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983; 98:958-972


Encyclopedia Britannica (2013). Herpes simplex. Retrieved from: http://www.britannica.com/EBchecked/topic/263650/herpes-simplex


Herpes.com (2011). Herpes. Retrieved from:  http://www.herpes.com/
Mertz GJ, Benedetti  J, Ashley R, et al. Risk Factors for the Sexual Transmission of Genital Herpes.  Ann Intern Med.  1992; 116:197-202

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