Genital Herpes

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    Genital herpes is usually the result of an infection by the herpes simplex virus type 2. The virus is highly contagious, and it passes from person to person through physical contact. In most cases, people contract the disease from an infected sexual partner. The virus causes an outbreak of small red sores on the genitals, buttocks, and inner thigh, and even after the sores go away, the virus remains in the body. People may experience additional outbreaks of the virus from time to time.

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    People who are in good health usually do not experience any additional complications from genital herpes. However, in some cases, people who have genital herpes will contract another sexually transmitted disease, such as AIDS. Women may experience urinary problems as a result of genital herpes, and men may develop proctitis, an inflammation of the rectal lining. Rarely, the herpes simplex virus can cause meningitis. Pregnant women can also pass the infection to their child.

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    Doctors can diagnose genital herpes by looking at visible sores if the outbreak is typical and by taking a sample from the sore for testing in a lab. Some cases of herpes are harder to diagnose, especially between outbreaks. Blood tests that look for antibodies to HSV-1 or HSV-2 can help to detect herpes infection in people without symptoms or between outbreaks.
    This information is based on source information from the National Women's Health Information Center.
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    Although genital herpes sores may be visible to the naked eye, laboratory tests may be needed to distinguish herpes sores from other infections. For several years, the most common method of diagnosis has been the viral culture. A new sore is swabbed or scraped, and the sample is added to a laboratory culture containing healthy cells.

    When examined under a microscope after several days, the cells show changes that indicate growth of the herpes virus. A major disadvantage of viral culture is that the specimen must be collected from a lesion or sore; when the lesion begins to heal, the test becomes unreliable. A test called the polymerase chain reaction (PCR) test is more sensitive than standard culture tests at identifying the herpes virus in the urinary and genital tracts; however, it is expensive and therefore not used very often.

    Blood tests have become more popular because they can detect evidence of infection even when sores are not present. These tests can be done on a small amount of blood taken from the arm or finger and, in some settings, results may be available immediately. Because they detect antibody (made by the body in response to the infection) they may not be positive until several weeks after exposure. Because most herpes simplex virus 2 (HSV-2) is genital, a positive blood test for HSV-2 usually indicates genital herpes. Because so many people in the United States have cold sores due to herpes simplex virus 1 (HSV-1), it is not routinely done. However, because genital herpes may be caused by HSV-1, a negative test for HSV-2 does not rule out genital herpes infection due to HSV-1.

    Interpretation of test results should be done by a clinician. A major advantage of the HSV-2-specific test is that it can be done when no sore is present. It may, therefore, detect infection in people who have not had recognized symptoms.
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    The risk for genital herpes being transmitted to your partner is based on several factors, but according to one report, in heterosexual couples in which only one partner is infected, over one year, the virus was transmitted in 10% of cases. In 70% of these couples, transmission took place when the infected person had no symptoms.

    If you experience an outbreak of genital herpes, whether primary or recurrent, you need to follow a few simple steps to improve healing and avoid spreading the infection to other parts of your body or to other people:
    • Keep the infected area clean and dry to prevent secondary infections from developing.
    • Avoid touching sores, and wash hands after contact with sores.
    • Avoid sexual contact until sores are completely healed (that is, scabs have fallen off and new skin has formed over the site of the lesions).
    People with early signs of a herpes outbreak or with visible sores should not have sex from the development of the first prodromal symptom until the sores have healed completely.

    Preventive therapy can decrease the frequency and severity of recurrent outbreaks by up to 90%. However, drug therapy doesn't significantly reduce the frequency of recurrences once it is stopped. Recurrence also tends to lessen in intensity and duration over time.
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    A , Family Medicine, answered
    Abstinence from sexual intimacy (direct genital contact; oral, vaginal, and/or anal sex) is the only 100% effective prevention. Condom use decreases transmission but is not totally effective because virus can be shed outside of the area that condoms cover. Use new condoms for each partner with any shared sex toys, or preferably, do not share sex toys.
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    There are things you can do to lower your risk of getting genital herpes:

    Don't have sex. The surest way to prevent any STI, including genital herpes, is to practice abstinence, or not having vaginal, oral, or anal sex. Keep in mind, you can get genital herpes from close contact other than sexual intercourse. Be faithful. Having a sexual relationship with one partner who has been tested for herpes and is not infected is another way to lower your risk of getting infected. Be faithful to each other, meaning that you only have sex with each other and no one else. Use condoms. Use condoms correctly and every time you have any type of sex. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a dental dam. Keep in mind that condoms may not cover all infected areas, so you can still get herpes even if you use a condom. Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a latex condom or dental dam correctly and every time you have sex. Talk with your sex partner(s) about STIs and using condoms. It's up to you to make sure you are protected. Remember, it's your body! If your partner is infected, take steps to lower your risk of getting herpes from your partner. Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. If you feel embarrassed, try to put this aside. Your doctor is there to help you with any and all health problems. Also, being open with your partners can help you protect your health and the health of others. Know the symptoms. Learn the common symptoms of genital herpes and other STIs. Do not have oral-genital contact if you or your partner has any signs of oral herpes, such as a fever blister. Seek medical help right away if you think you may have genital herpes or another STI. Don't have sexual contact until you have seen your doctor.

    This answer is based on source information from National Women's Health Information Center.
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    Until a vaccine is developed or research proves that antiviral drugs can stop transmission of the herpes simplex virus (HSV), the only effective means of preventing genital herpes is abstinence or consistent and correct condom use. This is because any type of unprotected vaginal, anal or oral-genital sex can transmit the virus.

    However, even condoms are not risk-free because lesions can occur outside of the area protected by condoms. The virus cannot penetrate through latex barriers. However, it is possible, although rare, to acquire infection during skin-to-skin contact if a lesion is present and not covered by a condom.

    The risk of transmission is greatest when an outbreak occurs. As a rule, experts say it is best to abstain from sex when symptoms are present and to use condoms between outbreaks. Since oral herpes can be passed to the genitals from oral contact, it is prudent to abstain from oral sex if a cold sore is present.

    Couples in long-term monogamous relationships in which one partner is infected must weigh the risk of infection against the inconvenience of always having protected sex. Most infections take place fairly early in a relationship and research indicates that a person may become less infectious over time.

    Women can use dental dams or plastic wrap to cover the vulva and help protect their partners from contact with body fluids during oral sex. The only dental dams approved by the U.S. Food and Drug Administration (FDA) for oral sex are Sheer Glyde dams. Because transmission can occur even when no lesions are present, always place a latex barrier between you and your partner's genitals and anus. Again, couples should abstain from sex during outbreaks, until the skin is fully healed.

    Lesbians or bisexual women should be aware that the herpes virus can be transmitted when a lesion from one woman comes into contact with the oral mucosa or the genital mucosa of her female partner.
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    There is no cure for genital herpes. Once you catch the virus, it remains in your body, and you can have outbreaks of the infection from time to time. In most cases, the symptoms of genital herpes will go away on their own in about 7 days. However, if you have frequent outbreaks, or if your symptoms are particularly painful, you should talk to your doctor. Your doctor can recommend medications to help ease and manage your symptoms.

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    A , Internal Medicine, answered
    Many people who have been infected by genital herpes don't have symptoms and are unaware of the disease yet are still infectious and spread the disease to their partners. Within the first week or two after infection, symptoms can include fatigue, muscle aches, and itching. Ten days or so after infection, a small blister usually appears in the genital region. The blister can burst and remain for several weeks, causing pain and discomfort. Once the initial outbreak heals, victims remain infected for the rest of their lives and may suffer recurrent outbreaks. Although herpes can be both painful and embarrassing, it is not life-threatening.
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