…..A few times a week a new case of genital herpes presents to my office, and the patient always experiences great psychological and physical pain and stress. The classic presentation of HSV (herpes simplex virus) is a painful group of vesicles and ulcers.
…..The infections are classified as primary, non-primary first episode, or recurrent. The primary infection is the most painful and may be associated with tender lymph nodes as well as a fever and body aches. If not treated, these primary lesions can last 2 to 6 weeks. Recurrences vary in their frequency; however, 50% of patients will have one within 6 months. These recurrences are generally milder with fewer lesions and a much shorter course.
Herpes, Type 1 and Type 2
…..HSV is a DNA virus classified into two subtypes, 1 and 2, based on various proteins making up the virus. HSV-1 is primarily the cause of herpes of the mouth and in the past was said to be the cause of infections above the waist. It can also be responsible for genital infections, and these infections are becoming more common, especially among young women.
…..HSV-2 is almost always a genital infection. The virus is spread through direct contact with mucosa (moist tissue like the vagina and lips/mouth) or damaged, irritated skin. Incubation of the virus lasts for about a week, and the virus then reproduces in the superficial layers of the skin, causing inflammation and damage. During the first infection, the virus enters the nerve cells and becomes dormant. The virus can reactivate and cause ulcerative disease or shed without any symptoms.
…..Let me leave you with a few facts:
- In the US, 20% of women have had an HSV-2 infection
- Most infections are spread by those who are unaware of having HSV
- Recurrent disease is more common in those with type 2, compared to those with type 1
Methods of Herpes Treatment
…..For now we will finish our discussion of herpes.
…..During a symptomatic outbreak, the treatment consists of supportive measures such as oral and topical pain medications and special genital hygiene. An antiviral medication can be added to decrease the viral shedding and the duration of the painful ulcers. These medications should be started at the onset of the symptoms.
…..Acyclovir and valacyclovir are the two most common antivirals used and have a long history of safety in pregnancy. There are some patients who experience frequent attacks, and a daily treatment of these medications can greatly suppress the episodes and therefore decrease the chance of spreading to a sexual partner.
…..In the future we will have a discussion of herpes and pregnancy, but for now I am going to get a donut.