Genital Herpes - Causes, Symptoms and Treatment
What is Genital Herpes?
Genital herpes is an acute inflammatory disease of the genitalia. The prognosis varies, depending on the patient's age, the strength of his immune defenses, and the infection site. Primary genital herpes usually is self-limiting but may cause painful local or systemic disease. In newborns and illlmunocompromised patients, such as those with acquired immunodeficiency syndrome, genital herpes is commonly severe, resulting in complications and a high mortality.
What are the Causes of Genital Herpes?
Genital herpes usually is caused by infection with herpes simplex virus Type 2,but some studies report increasing incidence of infection with herpes simplex virus Type 1. This disease typically is transmitted through sexual intercourse, orogenital sexual activity, kissing, and hand-to-body contact. Pregnant women may transmit the infection to newborns during vaginal delivery if they have an active infection and are shedding virus. Such transmitted infection may be localized (for instance, in the eyes) or disseminated and may be associated with central nervous system involvement.
What are the Signs and Symptoms of Genital Herpes?
After a 3- to 7-day incubation period, fluid-filled vesicles appear, usually on the cervix (the primary infection site) and possibly on the labia, perianal skin, vulva, or vagina of the female and on the glans penis, foreskin, or penile shaft of the male. Extragenital lesions may appear on the mouth or anus. In both males and females, the vesicles, usually painless at first, will rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, tender inguinal lymph nodes, and the characteristic yellow, oozing centers.
Other features of initial mucocutaneous infection include fever, malaise, dysuria and, in females, leukorrhea. Rare complications (generally from extragenital lesions) include herpetic keratitis, which may lead to blindness, and potentially fatal herpetic encephalitis.
Diagnosis for Genital Herpes
Diagnosis is based on the physical examination and patient history. Helpful (but non diagnostic) measures include laboratory data showing increased antibody titers, smears of genital lesions showing atypical cells, and cytologic preparations (Tzanck test) that reveal giant cells. Diagnosis can be confirmed by demonstration of the herpes simplex virus in vesicular fluid, using tissue culture techniques, or by antigen tests that identify specific antigens.
Treatment for Genital Herpes
Acyclovir has proved to be an effective treatment for genital herpes. I.V. administration may be required for patients who are hospitalized with severe genital herpes or for those who are immunocompromised and have a potentially life-threatening herpes infection. Oral acyclovir may be prescribed for patients with first-time infections or recurrent outbreaks; newer agents include famcyclovir and valacyclovir. Daily prophylaxis with acyclovir reduces the frequency of recurrences by at least 50%, but this is only appropriate for patients with frequent outbreaks, and it may not decrease transmission rates of the disease.
Special Considerations and Prevention Tips for Genital Herpes
1. Practice standard precautions.
2. Encourage the patient to get adequate rest and nutrition and to keep the lesions dry.
3. Advise the patient to avoid sexual intercourse during the active stage of this disease (while lesions are present) and to use condoms during all sexual exposures. Urge him to have his sexual partners seek medical examination.
4. Advise the female patient to have a Papanicolaou test as recommended by her gynecologist.
5. Explain to the pregnant patient with an active herpes infection about the risk to her newborn from vaginal delivery. Advise her that a cesarean delivery may help reduce the risk of passing the infection to her infant.
6. Refer patients to the Herpes Resource Center, which has local chapters nationwide.
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