Tuesday, August 17, 2010

Herpes By: Bradley G. Goldberg, M.D

Herpes simplex virus (HSV) is a very common infection. It is divided into two types: HSV type 1 which usually affects the mouth and lips, and HSV type 2 which usually affects the genitals. Although the infection can be controlled with medications, there is currently no cure for this virus. Therefore this infection creates not only physical discomfort, but also emotional and psychological distress as well.

Genital herpes currently affects one out of every ten people, about 30 million Americans. There are 500,000 new cases each year. Even more people have been exposed to the virus but are unaware of their infection because they either have no symptoms, or very mild symptoms. However, these asymptomatic individuals may still be capable of transmitting the virus to others through a process called “asymptomatic viral shedding”. The most likely time to transmit the virus is when active lesions are present, but asymptomatic shedding mandates that condoms be used at all times, though even that can not guarantee protection.

Symptoms may vary between individuals, but typically the first-time or “primary” infection will begin within 3 to 7 days of exposure. Usually many tiny blisters will appear on reddened skin. This is accompanied by tingling or itching, which then becomes very painful. These symptoms may also be accompanied by flu-like symptoms such as fever and generalized muscle aches. The infection tends to recur periodically, but recurrences are usually not as severe as the first outbreak. Things that may trigger a recurrence include sun exposure, fever, and physical or emotional stress.

Although there is no cure for this infection, there is relief in the form of antiviral medications. These include the drugs acyclovir, famciclovir, and valacyclovir. These medicines can shorten the duration of a first outbreak, and can also shorten or even prevent recurrences. Strong pain medicines may also be needed, especially with primary infections.

Special care must be taken during pregnancy if the woman has a history of genital herpes. Although it is rare for the newborn to contract herpes at delivery, it can be a very serious, and even life threatening infection for the baby. Cesarean delivery can help prevent transmission. The standard of care in this country is to deliver the baby by cesarean section if the mother has symptoms or visible blisters when she goes into labor. If no blisters are seen and if the mother has no symptoms, then she may undergo a natural vaginal delivery with very low risk to the baby.

In summary, genital herpes is a very common infection. In addition to the physical discomfort it can cause, it can also create significant emotional stress for the individual who must learn to cope and live with this infection. If a pregnant woman has a genital herpes outbreak at the time of labor, a cesarean section should be performed. If no lesions or symptoms are present, a vaginal delivery may be attempted. Remember that transmission can occur even when no blisters are present, so condoms should always be used.


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2. Glass’s Office Gynecology, Fifth Edition, Curtis and Hopkins, Williams & Wilkins, Pennsylvania. 1999.

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4. Williams Obstetrics, 20th Edition, F. Gary Cunningham,M.D. et.al., Appleton & Lange, Stamford, Connecticut, 1997