Genital Herpes

Genital herpes is a sexually transmitted infection caused by the herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Although most individuals are asymptomatic, following a two-week incubation period, patients will present with painful blisters surrounding the genitals and rectum. HSV-1 also commonly causes sores around or in the lips and mouth; these sores are known as cold sores. HSV-2 can also cause oral sores, although these are not as common. The genital blisters will break, forming ulcers that can take up to four weeks to heal. Subsequent outbreaks, especially in those infected with HSV-2, can occur in the following months or even years, although outbreaks tend to decrease in frequency and severity over time. Other symptoms might include swollen glands in the genital region, painful urination, vaginal discharge, fever, or headache. Genital herpes infections usually do not cause serious long-term health problems.

Genital herpes is transmitted by contact with an infected sore, typically via sexual contact. Unlike some other sexually transmitted diseases, using condoms does not provide complete protection against transmission, as the condom may not cover the entire area. Using condoms, however, will cut down on transmission rates even if they are not 100 percent effective. Although close skin-to-skin contact can transmit these viruses, they are not transmitted via toilet seats, towels, or other forms of casual contact. Women seem to be slightly more susceptible to infection than men. Pregnant women can also pass genital herpes to their babies, who can subsequently have serious eye, skin, or brain problems, although the risk of transmission is low, especially if the woman is diagnosed and treated prior to delivery.

Although there is no cure or vaccine for genital herpes, antiviral drugs can decrease the risk of viral transmission as well as reduce the severity and frequency of herpes outbreaks. These drugs include acyclovir, famciclovir, and valacyclovir. The drug valtrex can also reduce the likelihood that an infected person will pass the disease on to a noninfected sexual partner. Reducing the frequency and severity of herpes outbreaks is especially important in patients who are also at risk of HIV infection, as coinfection with an actively ulcerating sexually transmitted infection such as herpes greatly increases the chances of HIV transmission.

Partly because transmission can occur even when a patient is not actively infectious or even aware of the infection, genital herpes is quite common in most populations. In the United States, approximately 25 to 30 percent of the adult population carries the HSV1 or HSV-2 viruses, and incidence rates have been rising over time. Prevalence rates in other countries can range from 2 to 74 percent, and are generally much higher than those of other sexually transmitted diseases such as syphilis or gonorrhea. Although data [Page 727]are often scarce, many studies show that prevalence of herpes in countries outside the United States has also been increasing steadily since the 1970s, especially in Africa and countries of the former Soviet Union.

Promoting many of the measures that prevent HIV transmission will also help decrease herpes transmission, including condom use (although, as noted above, condoms are not as effective in preventing herpes as they are in preventing HIV), reducing the number of sex partners, and effectively treating active infections. Because herpes is an important cofactor of HIV infection, treating herpes infections is an important way to help cut HIV transmission rates.

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