Herpes simplex virus type 2 is the agent that causes genital herpes, a sexually transmitted disease (STD). It is usually contracted through sexual contact with someone who already has the virus. The typical skin lesions may appear within days of contact with the virus or take weeks, months or even years. The first outbreak may not show any symptoms and the person may be unaware he or she has the disease.
Signs and Symptoms
Classic symptoms include sores, vesicles, or ulcers of the skin in the genital area. They may resemble small pimples or blisters that crust over and form a scab. The lesions usually take between two and four weeks to fully heal. The lesions have also been mistaken for insect bites, abrasions, yeast infection, and "jock itch."
Other symptoms that may occur include flu-like symptoms such as fever and swollen glands, especially the lymph nodes near the groin. Headache and painful urination may be present.
Lesions can be found on the penis or vulva, near the anus, thigh, buttocks, or anywhere in the genital area.
The first episode is usually the worst while recurrent episodes have milder symptoms and faster healing lesions. The reason for this is thought to be that the body has developed an immune response that can deal with the infection more effectively.
Once the first infection occurs, the virus will go into a dormant phase and live in the nerve tissue of the lower spine. During reactivation, the virus travels along the nerve fibers that feed the genital region and cause more lesions as it reaches the surface of the skin. A person may have what is termed subclinical shedding with no signs of the disease, yet shedding virus capable of infecting others.
Reactivation Triggers
There are numerous factors that cause reactivation of the virus. These include:
- Illness
- Poor diet
- Emotional or physical stress
- Friction in the genital area
- Exposure to ultraviolet light
- Surgical trauma
- Steroid medications (e.g., prednisone and asthma medications)
Prodrome
In early reactivation of the infection, you may experience itching, tingling or painful feeling in the area where recurrent lesions will eventually develop. The amount of outbreaks varys with an average of 4-5 per year for HSV type 2. Severity and frequency of outbreaks decreases over time.
Treatment Options
There are three FDA approved antiviral medications available. They do not cure the disease, but can shorten the duration of the lesions and decrease the severity and frequency of outbreaks. They are:
- Acyclovir (brand name Zovirax)
- Valacyclovir (brand name Valtrex)
- Famciclovir (brand name Famvir)
Acyclovir has been available since 1982 in topical form and in pill form since 1985. It has been taken with safety for long periods of time.
Valacyclovir contains acyclovir as its active ingredient. More of this medication is absorbed by the body, so you can take fewer pills per day.
Famciclovir stops HSV from replicating, is better absorbed and persists longer in the body. Again, this medication is taken less frequently than acyclovir.
There are two ways to take antiviral medications. The first is episodic and is started at the first sign of skin lesions. The second is suppressive with the medication taken continuously; usually one or two pills per day. This method can reduce the frequency of outbreaks by up to 75 percent. For some, it may stop the outbreaks all together. Studies have also shown that suppressive treatment may prevent subclinical shedding.
Prevention
Most people with genital herpes do not have symptoms, so it is important to follow the prevention strategies listed below:
- Use condoms
- No sexual contact during an outbreak until completely healed
- Take suppressive medication
- Consider abstaining from sex (oral, vaginal, anal) during the last trimester of pregnancy
- Avoid oral sex if your partner has cold sores or fever blisters
Resources
American Social Health Organization
