Genital Herpes

Although most Canadians have heard of genital herpes, what they may not know is that 1 in 4 sexually active adults in the country has it, and that women are more likely to have it than men.

Genital herpes- while distressing and often painful - is more an annoyance for most people than a major health concern. If you are pregnant, however, it's a different matter: Genital herpes can be life-threatening for a fetus or newborn. In addition, having genital herpes puts you at a greater risk of acquiring HIV, the virus that causes AIDS.

Cause

Genital herpes is caused by the herpes simplex virus (HSV), a virus from the herpesvirus family that is made up of almost 100 kinds of viruses, including the varicella-zoster virus, which causes chickenpox and shingles, and the Epstein-Barr virus, which causes infectious mononucleosis.

There are two types of HSVs: HSV-1 and HSV-2. There was a time when HSV-1 was thought to be the herpes of "north of the border", only causing cold sores on the mouth, and that HSV-2, was the herpes that affected "south of the border", (with the border represented by the waist). Now it is clear that both types "go south" and cause genital herpes. In recent years, HSV-1 has been found to cause most primary outbreaks of genital herpes because of oral-to-genital contact.

Symptoms

Many people who have genital herpes do not even know they have it because they aren't aware of any symptoms.

What to look for:

• itching or burning feeling in the genital or anal area;
• pain running down the legs, in the buttocks, or in the genital area;
• discharge of fluid from the vagina;
• red bumps, blisters, or sores inside or near the vagina, on the penis, around the testicles, near the anus, or on the thighs and buttocks; the sores dry out, leaving yellow or gray scabs that fall off after a while, leaving no scar.
• tender lumps in the groin;
• cold sores around or on the mouth.

Transmission

HSV is passed from person to person through skin-to-skin contact, usually during genital or oral sex. It infects skin cells via mucous membranes and the thinner tender skin in and around the mouth, the genitals, and the anus. HSV can also infect skin cells through a cut or scrape. It can be passed from the mouth to the genitals, from the genitals to the mouth, from one part of your body (e.g., your genitals) to another (e.g., fingers, then eyes), and from pregnant woman to fetus or newborn.

HSV typically makes itself felt within a couple of weeks of transmission. Often the first outbreak is the worst, lasting about 2 to 3 weeks, and sometimes accompanied by a fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and/or swollen glands in the groin area.

Once you've got HSV, it stays with you for life. It takes up residence near the root of a bunch of nerves (ganglia) serving the area of transmission (usually the genital or mouth region). Whenever the virus becomes activated (often accompanied by a tingling or itching), it moves to the surface of the skin area supplied by the nerves, producing blisters. After some time, the virus goes dormant again, only to return to the same spot on the surface when reactivated.
Some people experience only a few outbreaks, others have them several times a year. No one knows for sure what causes the recurrences, but some sufferers find that sun, stress, or menstruation are triggers.

The virus is typically active on the surface of the skin about 15 percent of the time (this is called shedding). Half the shedding occurs just before, during, and after an outbreak, but the other half occurs completely at random. That's why people with genital herpes should always wear a condom.

Diagnostic

If you think you might have genital herpes, go to your doctor or another health-care provider to get tested, preferably during an outbreak. Current laboratory analysis include:

• viral culture: In this commonly used test, the doctor swabs the infected area (e.g., a sore or the cervix) and sends the swab to the lab. If you test positive you have genital herpes. If, however, you test negative you could still have it: there may not have been enough virus on the swab to be detected. Your doctor may advise you to wait until another outbreak to be tested again;
• blood test: If you continue to test negative a couple more times, and you've experienced signs and symptoms of the infection, your doctor may recommend a blood test to be sure. A blood test can also reveal whether it's HSV-1 or HSV-2.
• PCR: PCR (polymerase chain reaction) is a sensitive, new test, which is only now becoming more available across Canada.

If diagnosed with genital herpes:

• do not assume you got it from your most recent partner. Although the first outbreak usually makes its appearance within a few weeks, sometimes it takes years.
• work on strengthening your immune system by taking good care of your body, avoiding stress, getting enough rest and exercise, and eating healthy food.
• return for follow-up visits as requested by your doctor or clinic.
• inform people with whom you've had sex during the past 2 years; they too should be examined and counselled.

Risk

Those who are most at risk of contracting genital herpes include people:

• who have multiple sex partners.
• whose sex partners have multiple sex partners who have multiple sex partners who, etc.
• who don't use condoms.
• with a history of other sexually transmitted infections.

Treatment

At this point there's still no cure for genital herpes, but there are antiviral medications you can take that may shorten the outbreaks, make the sores less painful, and considerably reduce the chances of you transmitting the infection to your sexual partner(s). Antiviral therapies currently in use in Canada for treating recurrent outbreaks of HSV are valacyclovir (e.g., Valtrex™), acyclovir (e.g., Zovirax™), and famciclovir (e.g., Famvir™).

There are two ways that oral antiviral medications are used for the management of recurrences:

• episodically: if taken at the first symptom of an outbreak (when the tingling, itching or burning is first felt, before the blisters appear), episodic therapy may stop the virus from reproducing itself and thus help prevent the outbreak from becoming full-blown.
• continuously: If taken every day, suppressive medication may prevent outbreaks from occurring for up to 1 year. It may also shorten the length of time the sores last if they do appear and decrease the amount of time that the virus is active (i.e., is shed from the skin or mucous membranes between outbreaks, and thus present for transmission).

In order to decide which type of therapy is best for you, your doctor needs to know your complete medical history. Considerations such as pregnancy, kidney disease, HIV, and age, for instance, need to be taken into account.

Also, talk to your pharmacist about the effects - and side effects of any antiviral agents you are taking, especially with regards to long-term usage.

Living with genital herpes

A diagnosis of genital herpes does not mean that your sex life is over. What it does mean, however, is that you'll have to factor it in when making important life choices. You can live well with herpes.
At first, you may feel anger or grief or fear. Some people, on discovering they are infected with HSV, feel ashamed and isolated. They worry that people will reject them if the news gets out. These are normal reactions. Remember: you are not alone, millions of people have herpes. Talk to your doctor or another health-care provider and talk to your sex partner. You'll find that by treating the infection and managing the outbreaks, you'll lower the risk of transmission and sooth discomforts related to having the virus.

Tips during an outbreak:

• keep the infected area clean and dry to prevent other infections from developing.
• try to avoid touching the sores; wash your hands after touch sores (wash towels after using).
• after bathing, use a hair dryer instead of a towel around the sores, or pat dry gently.
• if urinating is painful, urinate in the bathtub just before getting out to dilute the urine so it doesn't sting the sores.
• if you find the discomfort too great, talk to your pharmacist who will help you choose the right analgesic to relieve your discomfort, such as acetaminophen (e.g., Tylenol™), or ibuprofen (e.g., Advil™).
• wear cotton, not nylon, underwear and wear loose-fitting clothes.
• avoid sexual contact from the time you first feel any symptoms until the sores are completely healed; that is, until the scab has fallen off and new skin has formed where the sore was.

Prevention

There's no way to guarantee you won't pass it on. Studies show that within a year, 4 percent of men and 10 percent of women catch genital herpes if their mate has it. However, if you or your partner has genital herpes, you can reduce transmission rates by about half by:

• always using a latex or polyurethane condom (male or female) when having sex.
• avoiding sexual contact during an outbreak: from the time the infected partner first feels any symptoms (such as tingling) until the sores are completely healed.
• the infected partner taking antiviral medication.

For more information :

The Society of Obstetricians and Gynaecologists of Canada

www.sogc.org

Sexuality and U

www.sexualityandu.ca