The family herpes – concluding with genital herpes
The journey through the herpes virus family has taken us from chickenpox and its very close relative shingles (July issue), through cold sores and other manifestations of type1 herpes (August issue) to genital herpes caused mainly by type 2 herpes but also by type 1. The various conditions are all very different but the common threads remain – that is, any particular herpes infection is permanent and subject to flare-ups throughout life but they are all amenable to antiviral medication.
This final instalment introduces herpes in sexually transmitted disease which unfortunately is a frequent worry amongst our patients.
Type 2 causes most cases of genital herpes which is transmitted by skin to skin contact and condoms do not necessarily protect. Type 1 commonly produces cold sores on the lips but can be transmitted from the mouth to the genitals during oral sex. Transmission of either type is most likely when the infected person actually has visible active lesions but transmission can also occur when there are no visible sores (and the person may not even know they are infected).
The first outbreak can be severe and usually occurs within 2 weeks of being infected although many people have either no symptoms or very mild lesions which may be mistaken for insect bites or some other skin condition. More severe episodes start with a tingling discomfort prior to the appearance of small painful blisters filled with clear fluid which burst and leave painful sores that crust over and heal in about 7 to 14 days. Subsequent episodes are usually less severe and shorter than the first outbreak and tend to get less frequent over the next 2-3 years – type 1 has fewer recurrences than type 2.
The initial outbreaks can be associated with fever, malaise and loss of appetite and general aches and pains and can make urination painful. The recurrences can be triggered by physical or emotional stress, fatigue or genital irritation or trauma. Subsequent outbreaks usually last 2-3 days and may not need treatment.
Diagnosis is based on appearance (and patient’s sexual history) and can be reinforced with blood tests that check for antibody levels to the herpes virus – although the blood tests can also be positive in infected people who have never had symptoms.
Once recognised, treatment with an oral antiviral such as aciclovir “Zovirax” should be started as soon as possible, preferably when the skin tingling begins. Some people, who have frequent outbreaks, take this medication daily over a period of time to prevent attacks whereas others may have a year or more between recurrences. Pregnant women may be treated during the last month of pregnancy to avoid an outbreak around delivery and a Caesarean section is recommended to reduce the risk of infecting the baby.
The surest way to avoid STDs and to enjoy sex is to be in a long-term mutually monogamous relationship with a partner who is known to be uninfected. If one or other partner is infected, then condoms can reduce the risk of transmission but are less effective if a lesion is not covered by the condom (genital herpes often affects the outer skin in the female). Intercourse should be avoided completely even with a condom if spots or sores are present. The situation is complicated also by infected persons shedding the virus even when they have no lesions although the risk of transmission is more with visible active lesions. The infection affects about 1 in every 5 women and about 1 in every 9 men, in persons aged 14 to 49 years, so unprotected sex with consecutive or multiple partners is extremely risky.
So that completes the journey around this little family of viruses, this piece with some polishing up by Dr Rosemary! They are not generally life-threatening but they are life-long once encountered although nowadays they respond to antiviral medication that can shorten attacks.
If you missed the previous related articles, you can find them online at www.theislander.net under “Features”.
Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca.