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Genital Herpes in Women

What is herpes?
Herpes is a common viral infection usually transmitted through skin-to-skin contact. There are two basic strains of the virus: HSV-1, known as oral herpes and HSV-2 which is known as genital herpes. HSV-1 is often transmitted through kissing. It is most commonly identified as a cold sore, sometimes called a fever blister, on the lips or mouth. It can also be transmitted to the genital area through oral sex. HSV-2 is most often transmitted by sexual contact with an infected person.
Signs and symptoms of genital herpes
Most people have no idea that they have been exposed to the herpes virus because they don’t show any symptoms. If symptoms do occur, they may be very uncomfortable. These symptoms may occur within about two weeks of exposure. The period of active infection (also called an outbreak’) is defined as the time when one or multiple blisters develop in the affected area, causing a variety of symptoms. The initial outbreak of herpes is usually the most severe because the body has just recognized a new virus and has not yet started to develop antibodies against it. Initial symptoms may include swelling of the lymph nodes in the neck, underarm and groin areas. There may also be a generalized feeling of being under the weather, similar to how one feels when they have the flu. Other symptoms include fever, fatigue, headache, muscle aches accompanied by itching, swelling and discomfort in the genital area. Blisters may form anywhere in the genital area as well as the anus or rectum. They later burst to form open sores that may cause pain and burning during urination or defecation. The blisters later begin to dry, form a crust, and eventually heal within two to four weeks. They do not typically leave any scarring. After the first episode of genital herpes, the average rate of occurrence is usually four or five symptomatic outbreaks per year. However, each individual is unique and some people experience more frequent outbreaks while others may have less. In general , subsequent outbreaks tend to decrease in frequency and severity over time.
The virus stays in the body forever, sometimes remaining inactive indefinitely. During this time of inactivity, the person has no symptoms of herpes but they may still be capable of passing the virus on to others. It is unknown exactly was triggers the virus to become active again in the body. Menstruation, wearing tight clothing, a weakened immune system and friction or irritation of the skin have been identified as potential triggers. What triggers an outbreak in one person may not do so in another.
. Incidence
Genital herpes is one of the most common sexually transmitted diseases in the United States. According to the CDC (Centers for Disease Control), about 1 out of 4 women and almost 1 out of 8 men has been infected. Male-to-female transmission is believed to be more likely than female-to-male transmission. In comparison, about 8 out of 10 adults may have been exposed to HSV-1 by the time they are 25 years old. However, only a small number of these people will actually develop symptoms such as a cold sore.
Diagnosis
Several diagnostic tests are available to test for herpes. Some tests have proven more accurate than others. Cultures, rapid detection and HSV DNA blood tests have all been used. However, for most people, a health care provider can make the diagnosis based on signs and symptoms accompanied by a thorough history and physician exam.
Treatment
There is no cure for herpes. During periods when there are no symptoms of infection, the virus remains dormant in the body. When outbreaks occur, they may cause mild discomfort or even severe pain. Mild analgesics such as aspirin or acetaminophen may be taken as needed. There are also treatment options that may lessen the severity, frequency and duration of outbreaks. Antivirals are used to treat infections such as herpes. Valcyclovir, famciclovir and acyclovir are some commonly used medications that may be prescribed and taken orally . There are two basic types of therapy. Your health care provider will assist you in deciding which type of therapy will best meet your individual needs.
Episodic therapy. This means that antiviral medication is taken only when there is an actual outbreak. At the first sign of an outbreak such as itching, blisters or tingling in the genital area, the medication is started. The goal for this type of treatment is to decrease the duration and severity of an individual outbreak.
Suppressive therapy. This is also sometimes called preventive therapy. It is the treatment of choice for those who have a history of frequent and / or extremely painful outbreaks. The antiviral medication is taken daily for an indefinite period of time whether or not there is an outbreak. One advantage of taking medication continuously is that there may be a reduction in the frequency and severity of future outbreaks. There may also be a decreased risk that the virus is transmitted to another sexual partner. Another option for preventive therapy is to take the medication only when an outbreak is expected to likely occur such as during menstruation or when stressful events is expected to occur.

Besides conventional treatment options, a variety of natural and alternative methods are also available:

The following have been found to possess antiviral properties which may aid in the prevention and treatment of herpes outbreaks:
Vitamin C
Zinc
Lysine
Aloe vera (topical or taken orally)
Lemon balm
Licorice (topical or taken orally)
Echinacea
Andrographis
Olive leaf
Lithium

Additional alternative methods include:
Photo-therapy using UV light
Holistic approaches such as stress management, deep breathing exercises and guided imagery to decrease stress.
Herpes and pregnancy
Sexually transmitted diseases (STD’s) such as herpes can be passed from a pregnant woman to her baby at any time during pregnancy and delivery. To decrease the chances of active herpes around the time of delivery, suppressive therapy may be prescribed. An active outbreak of herpes may increase the risk of premature labor and premature rupture of membranes. In rare cases, genital herpes can lead to fatal infections in infants. Newly acquired genital herpes infections during late pregnancy run a higher risk of transmission to the infant. The risk of transmission decreases for women who had herpes prior to the pregnancy. In cases where active genital herpes is present during labor and delivery, a cesarean delivery is usually performed. Overall, the incidence of a mother transmitting herpes to her unborn child or infant is very small. The low incidence may be related to herpes antibodies that are present in the mother’s blood which cross the placenta to the fetus.
Infants of mothers who have had STD’s such as herpes may develop complications during the perinatal period such as: low birth weight infants, prematurity, neurological damage, blindness, pneumonia and sepsis as well as other infections. Early and regular prenatal care is important in preventing and identifying any potential problems.
A small percentage of babies are infected with herpes after birth. The infection can often be traced back to being kissed by someone who has an active oral lesion. It is important that those handling the infant are educated about the importance of good hand washing as well as the avoidance of kissing the infant if they have anything resembling an active cold sore.
Prevention
The best way to avoid herpes and all other STD’s is abstinence or being in a long term monogamous relationship with someone who does not have herpes. People with herpes should also abstain from sexual activity with their uninfected partners when an outbreak occurs. Consistently and properly using latex condoms may also help decrease chances of herpes transmission along with other STD’s. As mentioned earlier, it is important to remember that even if a person does not have any symptoms, they can still infect a sexual partners.

With time, many people learn specific triggers that bring on outbreaks. Learning to avoid those triggers may help to lessen outbreaks. Keeping the immune system functioning optimally may be another key factor that prevents outbreaks. A good diet, exercise, rest and keeping stress to a minimum may all help keep the immune system strong. Whenever outbreaks occur, good hand washing should be done if blisters are touched to prevent transmission.

Living with herpes

Herpes can cause psychological distress for those who are infected. Some people feel angry or depressed. Others may develop lowered body image and self esteem as a result of the diagnosis. Feelings of being victimized and helplessness can occur. One key to help feel some control over the situation is through education and learning ones own body. Simply by paying attention to signals the body gives, it may be possible to recognize and predict outbreaks, which makes early treatment along with decreases severity and duration of outbreaks possible. Keeping track of outbreaks and the events surrounding those outbreaks may help identify possible triggers. Having herpes does not make someone a bad person. Remember that herpes, while not curable at this time, more research is being done on vaccines and other advanced ways to prevent and treat herpes.