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Paging Dr. Frischer - Genital Herpes
WRITTEN BY :   Dr. Alan Frischer

This week’s article concerns an incurable disease that afflicts about one in every five people (approximately 67 million) in the United States! Every year there are 500,000 new cases. This disease is preventable with common sense and some specific protective behaviors.
I am referring…of course…to genital herpes.
What is herpes, and how do you get it? Two viruses, herpes simplex 1 (HSV1) and herpes simplex 2 (HSV2) are responsible. In its most common form, an HSV infection involves the face and mouth, the lesions are cold sores, and it is considered oral herpes. Most typically the cause of oral herpes is HSV1, although HSV2 is possible. Genital herpes is the second most common form of herpes, and is typically caused by HSV2 (although HSV1 is possible).
Genital herpes is contracted through direct contact with an infected person’s active lesion or body fluids. The virus then travels through tiny breaks in the skin or mucous membranes (which include the genital area). Genital herpes is mostly asymptomatic (without symptoms), but note that even when asymptomatic, disease transmission can still occur through viral shedding (the virus can still reproduce and cause infection). Passing along herpes when symptoms are not apparent is most likely during the first year of having the virus.
What about toilet seats? In theory, the virus can indeed live on a toilet seat for two to four hours. However, evidence of transmission from this source has never been well documented.
Herpes cycles between periods of activity and remission. Triggers for a herpes outbreak include physical as well as psychological factors. Common physical factors include being run down, suffering from other genital infections, menstruation, drinking large quantities of alcohol, exposure to sunlight, other UV light exposure such as tanning booths, and any disease that weakens the immune system. Psychological factors include prolonged stress and anxiety.
Infections occur 2 to 12 days after exposure to the virus. Symptoms include tingling, itching, burning or pain, followed by the appearance of the classic blisters. That first outbreak of lesions is called the initial or primary infection, and tends to be the most severe. The blisters contain infectious viral particles and last between 2 and 21 days, followed by a remission period during which the sores go away. There may be fever, fatigue, body aches and headaches. In women, the sores for genital herpes most often involve the vulva and entrance to the vagina. In men, sores are most commonly seen on the glans (end), foreskin and shaft of the penis. While some people never experience a recurrence of this initial infection, for those who do, the episodes over time tend to be less severe and less frequent.
A herpes diagnosis, practically speaking, is made by a visual inspection of the sores. To confirm the diagnosis, the doctor may perform a swab test, in which a sample of the fluid is taken from a blister, ulcers, or a genital secretion. While many who are infected will develop the classic skin lesions, for others the first clue that they have the disease is when their partner develops it. Up to 60% of people who have genital herpes show NO SIGN. Occasionally, one partner in a long-term relationship may develop symptoms of herpes for the first time because one or both of them were unaware of being carriers of a silent HSV infection. The sudden appearance of herpes does not necessarily imply recent transmission from someone outside the relationship. However, it makes the task of controlling the spread of herpes extremely difficult when those infected may be unaware that they have the disease.
There is no cure for herpes, and no vaccines available to prevent the infection. The current focus is on treatment to reduce viral reproduction and shedding, preventing the virus from entering the skin, and lessening the severity of symptomatic episodes.
What else can the herpes virus do to the body? In addition to the common oral and genital infections, there are more serious infections that can infect and damage the eyes (herpes keratitis), or invade the central nervous system and cause brain damage (herpes encephalitis). Recurrent skin infections can occur anywhere on the body where contact has been made, causing blisters and pain. Bell’s Palsy has been linked to the presence and reactivation of the herpes virus inside the sensory nerves of the face.
Prevention is the best policy, and for genital herpes, condoms are highly effective in limiting transmission. The virus cannot pass through a condom; however, the condom may not completely cover all the sores or protect all of the skin. As is true for all STD’s, women are at higher risk of getting the disease from men then vice-versa. On an annual basis, without the use of condoms or antiviral medication, the transmission risk from male to female is 8-10% per year. The transmission risk from female to male is 4-5%. Taking an antiviral medication cuts that risk in half. Condom use also cuts the risk in half. Using both cuts the risk by 75%.
Treatment for the symptoms of an outbreak includes taking salt baths, wearing loose underclothes, and using common analgesics such as Tylenol or Advil. Antiviral medications such as Valtrex or Zovirax reduce the length of an outbreak as well as the severity. Those who suffer from frequent and painful recurrent episodes typically take the antiviral medicine daily, and it can also be used on an episode-by-episode basis.
What does it mean to have genital herpes?
• Have open and honest discussions with your partner(s)
• Refrain from sexual activity during an active outbreak of the disease
• Use condoms to lessen the risk of transmission
• Consider using an antiviral medicine to lessen the risk of transmission
• In an on-going relationship, where both partners fully understand the chance of transmission, they may wish to consider the choice to use condoms
• Become a member of a support group
• Speak with your doctor regarding the diagnosis, prevention, and treatment of this disease
Be well, and be safe!
Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.
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Published: January 23, 2009 – Volume 7 – Issue 40



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