Herpes is a sexually transmitted disease (STD)
caused by the herpes simplex virus (HSV).
Genital herpes infection is very common and on the
increase. It is more common in women (1 out of 4)
than in men (1 out of 5) possibly because male to
female transmission is more efficient than female
to male transmission.
HSV-2 infection is also more common in areas of
high socio-economic disadvantage, facing
fundamental issues of health such as:
The Herpes Virus
be inactive or 'silent' causing no symptoms
cause either genital or oral infections
cause 'outbreaks' of blisters and ulcers
People can remain infected for life after the
first initial episode
Herpes is spread by direct contact including:
as well as
Can be transmitted with or without the presence
of sores or other symptoms
Is often transmitted by people who do not
realize infection can be passed on even when
there are no symptoms
Is often transmitted by people unaware they are
An estimated 40 million people have genital
herpes which is a chronic viral infection
About 500,000 new people get symptomatic herpes
There are even more people without symptoms
Genital herpes infection
has increased most dramatically among young
white teens (12-19 years old)
among whites is 5 times higher than 20 years ago
is twice as likely to infect 20-29 year old
How serious is Herpes?
Mild symptoms can be experienced with HSV-2, but
often no apparent symptoms are present.
HSV-2 may cause recurrent painful genital ulcers
and can be severe in people with suppressed immune
systems. Severe genital herpes frequently causes
psychological and emotional stress.
If a woman with HSV-2 is pregnant, potentially
fatal infections in infants can occur. A
caesarean section delivery is usually carried out
if a woman has active genital herpes at time of
People infected with herpes may be more
susceptible to HIV infection, and HIV-infected
individuals may be more infectious.
How do you know if you are infected with genital
Many people with HSV-2 are sometimes not aware
that they are infected.
Some people infected with HSV-2 do not have
lesions or may suffer only very mild, almost
unnoticeable, symptoms which are sometimes
mistaken for insect bites or a rash.
Symptoms of the primary episode can be quite
pronounced. The primary episode usually occurs
within two weeks after the virus is transmitted
and lesions usually heal within 2-4 weeks of
Other symptoms may include a second crop of
lesions, or flu-like symptoms including:
A primary episode of genital herpes can cause
several symptomatic recurrences a year (average 4
or 5). Most recurrences occur more often within
the first year following the primary episode.
Herpes simplex, a recurrent viral infection,
caused by Herpes Virus hominis (HVH), is a
widespread infectious agent, which is very hard to
control. As well there are latent herpes
Symptoms vary, but often most people have no
Early symptoms may include:
Small red bumps may appear in the genital area
after initial symptoms, which later develop into
The blisters usually:
form a scab
The First Outbreak
Symptoms usually develop within 2-20 days after
contact, but could continue up to 2 weeks.
The first infection may be so mild it goes
unnoticed. In other cases, the first attack causes
visible sores. Subsequent recurrences of the virus
may cause an outbreak of blisters.
The virus retreats into the nerves and lies
dormant. Even when there are no symptoms of
herpes, transmitting the virus is still possible
(asymptomatic viral shedding).
Healing of the skin does not normally leave
When it gets into skin cells the virus reproduces
itself and starts to multiply, making the skin
red and sensitive.
Blisters or bumps may appear on the genital area,
the blisters first opening and then healing with
the regeneration of new skin tissue.
During the outbreak the infected area may:
Other symptoms include:
infection of the urethra causing a burning
sensation when urinating
painful inflamed blisters which develop around
the infected area
swollen lymph glands
vaginal or penis discharge
The first episode is the most severe, with most
episodes lasting 10-21 days. A warning sign (prodrome)
such as tingling is experienced by many people in
Should any of these symptoms occur, consult your
doctor or other health care provider immediately.
Genital herpes should be diagnosed and treated
DIAGNOSIS & TESTING
Diagnosis can be made by:
In this process, scrapings from lesions are
stained and then examined under a microscope.
This test is less accurate than viral cultures, as
it is difficult to ascertain which type of HSV
infection is present.
Viral Cell Culture Test
The test is a specific virus culture or assay for
The doctor or health consultant will obtain fluid
from the sores and send it to a laboratory to see
if the herpes virus is present.
A viral culture is a fluid sample taken from a
lesion when it first appears. Highly accurate
results can be given from a culture taken while
the lesion is still in the clear blister stage,
but the process takes a few days.
The test will not work if the sores have healed.
Immune Response Tests
These tests detect the body's immune response to
the herpes virus and are slightly less reliable
than viral cultures, but more reliable than
Other available tests:
Identifying Your Type
Not everyone knows whether they have HSV-1 or 2
and in certain situations that information could
In a situation where both partners have HSV-2 both
are already infected so precautions to prevent the
spread of the disease are optional.
If one partner has genital HSV-1 and the other has
HSV-2, each might get infected with a second type
unless precautions are used.
Diagnosing genital HSV- 1 is difficult because the
infection seldom recurs. Since many people have
HSV-1 orally, a finding of HSV-1 by Western blot
serology (blood test) would not positively
identify genital infection.
A Western blot confirms if you have HSV-2. If you
are seronegative (negative by blood test) for type
2, but positive for type 1, that gives you a
strong clue as to the cause of your outbreaks,
i.e. seropositive for type 1 but not type 2, with
infrequent recurring genital herpes is probably
Seek immediate professional help if genital herpes
is suspected. Some of the available diagnostic
procedures become less reliable the longer you
CONDITIONS CONFUSED WITH HERPES
Listed below are some other conditions sometimes
mistaken for herpes:
Bacterial or yeast infections
Canker sores (aphthous ulcers)
are grey with a distinct edge
usually occur inside the mouth
usually heal within 10-14 days without treatment
is a highly infectious bacterial disease
often produces crusty blisters
is more common among children
Molluscum contagiosum (molluscum)
like herpes, molluscum is a viral infection of
unlike herpes, molluscum produces lesions that
are raised, with a central dimple
Unlike genital herpes, Syphilis does not usually
produce a cluster of blisters, and it usually
responds well to antibiotics.
is spread through:
To help prevent the spread of herpes:
avoid any sexual contact if you are infected
limit the number of sexual partners
use latex condoms
visit a local sexually transmitted disease (STD)
clinic, hospital, or your doctor if you are
can be spread by people with no noticeable
is also transmitted through:
caressing infected areas
Associated Herpes Viruses
Herpes is a disease posing great risk to the
community and is of growing public health
importance. Keeping yourself informed is your best
protection. The Herpes family of viruses is large.
These viruses cause or are associated with a whole
spectrum of diseases ranging from infectious
mononucleosis to malignancies and mental
retardation and have the ability to cause more
than one kind of disease.
Herpes Type I
affects the skin and mucous membranes
is transmitted by oral and respiratory
produces cold sores or fever blisters
Herpes Type II
is transmitted by sexual contact, with
cross-infection possible from oral/genital sex
primarily affects the genital area
Approximately 85% of all HV infections are
sub-clinical, the others produce localized lesions
and systemic reactions.
After the first infection, a patient is
susceptible to recurrent infections brought on by:
heat and/or cold
In recurrent infections there may be no
constitutional signs and symptoms. Herpes occurs
equally in males and females.
Herpes Zoster (Shingles) is an acute unilateral
and segmental inflammation of the dorsal root
ganglia caused by infection with the herpes virus,
varicella-zoster, which also causes chicken pox.
usually occurs in adults producing:
Unless the infection spreads to the brain
eventually most patients recover completely,
except for possible scarring and, in corneal
damage, visual impairment. However, in some cases
neuralgia may persist for months or years.
Herpes zoster results from reactivation of the
varicella virus that has lain dormant in the
cerebral ganglia or the ganglia of posterior nerve
roots after infection from chicken pox.
The virus is thought to multiply as it is
reactivated and is neutralized by antibodies
remaining from the initial infection. However, the
virus continues to multiply in the ganglia,
destroys the host neuron, and spreads down the
sensory nerves to the skin if effective antibodies
are not present.
Herpes zoster is found primarily in adults over 50
and seldom recurs.
Onset of herpes zoster is characterized by:
Within 2-4 days, severe deep, continuous pain may
hyperesthesia (abnormally increased sensitivity
paresthesia (an abnormal or perverted sensation,
such as burning or tingling due to disorder of
the sensory nervous system)
This usually occurs on the trunk and occasionally
on the arms and legs lasting from 1-4 weeks.
Small red nodular skin lesions can continue to
erupt on the painful areas up to 2 weeks after the
Infection by the cytomegalovirus (DNA, ether
sensitive virus belonging to the herpes family)
occurs worldwide and is transmitted by human
About 4 out of 5 people over the age of 35 have
been infected with cytomegalovirus usually during
childhood or early adulthood. In most of these
people, the disease is so mild that it is
CMV infection during pregnancy can be hazardous to
the fetus, possibly leading to:
other birth defects
Transmission usually occurs through contact with
the infected secretions, which harbor the virus
for months or even years
AIDS patients or those who have received
transplanted organs are a high risk for
contracting CMV infection.
Immuno-deficient patients and those receiving
immuno-suppressives may develop pneumonia or other
Recipients of blood transfusions
Recipients of blood transfusions from donors with
positive CMV antibodies are at some risk
Cytomegalovirus is thought to be spread through
the body in lymphocytes or mononuclear cells to
the lungs, liver, and central nervous system where
it often produces inflammatory reactions.
The disease usually runs a self-limiting course.
Infectious mononucleosis is an acute infectious
disease caused by the Epstein-Barr virus (EBV), a
member of the herpes group which usually affects
young adults and children.
Recovery prospects are excellent
with symptoms similar to mononucleosis include:
Symptoms usually subside about 6-10 days after
onset of the disease but may persist for weeks.
Over 80 known viruses exist within the Herpes
family, 8 of which are known to cause disease in
humans, the most common being Herpes simplex virus
1 and 2.
HSV-1 and HSV-2 look identical under the
microscope, and either type can infect the mouth
or genitals. HSV-1 usually occurs above the
waist, and HSV-2 below the waist.
HERPES SIMPLEX VIRUSES
Herpes simplex virus 1 (HSV-1)
Herpes simplex virus 1 (HSV-1) commonly causes
herpes labialis also called:
The virus produces highly infectious open sores
that crust over before healing.
Although less probable, HSV-1 can also cause
Herpes simplex virus 2 (HSV-2)
Herpes simplex virus 2 (HSV-2) is a contagious
viral infection primarily causing genital herpes
in men and women.
genital herpes include:
HSV-1 and HSV-2
HSV-1 and HSV-2 can cause other diseases
Herpes simplex encephalitis
an HSV infection of the finger
caused from transfer of the infection from
another part of the body or from direct contact
is more prevalent amongst health care workers
an HSV infection, usually of the skin, acquired
skin can become abraded or scraped, during a
wrestling match, allowing a herpes virus to
enter the body and establish an infection
Unlike viruses such as influenza which can be
transmitted through the air, herpes simplex
viruses require physical contact.
They are frequently transmitted through:
Herpes Viral Infection
Some common herpes viruses and the diseases they
Herpes simplex type 1 (HSV-1)
Herpes simplex type 2 (HSV-2)
Epstein-Barr virus (EBV)
FINDING A TREATMENT THAT WILL WORK BEST FOR YOU.
Genital herpes is manageable. Over the years, a
number of treatments offering effective relief
from symptoms of genital herpes and cold sores
have been developed
OTC "cold sore" treatments,
The standard, effective and specific treatment for
genital herpes is antiviral therapy, which is
usually in tablet form.
Antiviral drugs stop HSV from replicating in the
body. The treatment only works while you are
taking the drug, and cannot prevent future
outbreaks once you stop taking it.
Antiviral treatments can:
shorten the duration of a genital herpes
outbreak and help speed healing
reduce the number of outbreaks suffered - or
prevent them completely
Antiviral medications can be used in two ways:
1. To treat outbreaks as they happen ('episodic'
treatment). With episodic treatment, the aim is to
shorten the time each outbreak lasts and to
relieve symptoms. If you are coping well and your
outbreaks are not too frequent, you and your
doctor may agree that episodic treatment is the
most appropriate option.
2. To prevent or delay recurrent outbreaks
('suppressive' therapy). If your recurrent
outbreaks are frequent or severe your doctor may
recommend that you take oral antiviral medication
every day to help prevent outbreaks happening.
Suppressive therapy is taken continuously, e.g.
daily, for months or even years.
Simple SELF-HELP remedies for the relief of
The following non-specific treatments can help
alleviate the pain and discomfort:
BATHS: used to wash the genital area, can clean,
soothe and dry the sores. Use 1 teaspoon of salt
in 600 ml of water or a handful in a shallow bath.
RELIEVERS: Include simple analgesics such as
Aspirin and paracetamol
Ice can be soothing if applied directly to the
Creams with an anaesthetic component
Creams, however, can slow down drying and should
therefore be used sparingly and only for pain
relief. In addition, topical creams have limited
value on moist mucosal surfaces, particularly in
UNDERCLOTHES: preferably cotton (not nylon), can
help minimize discomfort and allow healing.
anyone experiencing extreme pain when urinating,
the process can be less painful when done in a
cool bath. And it is important to remember to
drink plenty of fluids as this dilutes the urine.
may be prescribed to ease the emotional stress of
herpes, particularly Rescue Remedy
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