Genital Herpes

Genital Herpes is an infection of the genito-anal area with genital Herpes simplex virus (HSV) type 1 or type 2, a DNA virus of the Herpesviridae family. Genital herpes is usually caused by herpes simplex type II virus but can be due to herpes simplex type I virus which is more commonly associated with cold sores around the mouth. The incubation period of genital herpes is three to nine days if symptoms occur. However, up to 90% of primary infections may be asymptomatic.

The first attack of genital herpes, called primary infection, is associated with generalised illness which can be severe. The external genital skin becomes red and painful and there are typical blisters called vesicles.

Genital Herpes Picture 1

This picture shows an example of the early stages of the herpes rash. The cluster of vesicles all appear to be on the same red base. This is different from the rash of chicken pox which has an individual vesicle on a red base.

Genital Herpes Picture 2

Genital herpes sores may be clear, fluid-filled blisters that develop in an area of redness. The herpes virus is active, and transmission is likely.

Genital Herpes Picture 3

The clear fluid in the sores eventually becomes cloudy and yellow as pus forms. The genital herpes virus is active, and transmission is again likely.

Genital Herpes Picture 4

This picture shows typical genital herpes lesions on a penis, including vesicles and ulceration. Because the number of lesions is extensive this may be a first outbreak of genital herpes for this person. Typically, the first genital herpes outbreak is worse than recurrent outbreaks.

Genital Herpes Picture 5

A further picture of herpes lesions in the later stages of healing. There is some crusting.

Genital Herpes Picture 6

Genital Herpes on the Vulva

When the blisters open they become painful ulcers. Blood and viral culture tests are usually undertaken to confirm the diagnosis which is usually apparent to the doctor who will often commence treatment with an antiviral agent (e.g. acyclovir - Zovirax - Glaxo) before awaiting laboratory confirmation. At times the infection may be so painful, the illness so weakening or bladder emptying so difficult that admission to hospital is required.

Repeat attacks, called secondary herpes, are less severe than primary infections. They last for between five and ten days if left untreated. There may be symptoms of impending problems 12-72 hours before vesicle eruption, with tingling or burning sensations. Attacks are thought to be more common at times of stress. Treatment with an antiviral agent at the onset of warning symptoms will lessen or prevent attacks. Sufferers should abstain from sexual intercourse during attacks to save the partner from infection. Whilst individual attacks can be thwarted, there is no long-term cure. When attacks occur more frequently than six times in a year, there may be understandable depression. For the minority with such frequent attacks there is a place for regular twice daily acyclovir tablets.

If there is active genital herpes around the time of childbirth, the baby can be infected with severe consequences. It is believed that this is more dangerous with the primary infection. If there is evidence of genital herpes around the time of delivery, Caesarean section reduces the risks.  

Recommended Books:

 Genital Herpes

Treatment

A number of treatments offering effective relief from symptoms of genital herpes have been developed.

The following treatments can alleviate the pain and discomfort of genital sores:

Salt baths, used to wash the genital area, can clean, soothe and dry the sores. Use 1 teaspoon of salt in 600 ml of water (about a handful) in a shallow bath.

Analgesics (such as aspirin and paracetamol), ice (which can be soothing if applied directly to the sores) and creams with an anaesthetic component. Creams, however, can slow down drying and should therefore be used sparingly and only for pain relief. In addition, topical creams have limited value on moist mucosal surfaces, particularly in women.

Loose underclothes, preferably cotton (avoid nylon), can help minimize discomfort and exacerbate healing.

Antiviral Therapy For Genital Herpes

The standard, effective and specific treatment for genital herpes is antiviral therapy, which is usually in tablet form. Antiviral drugs stop HSV from replicating in the body. The treatment only works while you are taking the drug, and cannot prevent future outbreaks once you stop taking it.

Antiviral treatments can:

shorten the duration of a genital herpes outbreak and help speed healing

reduce the number of outbreaks suffered - or prevent them completely.

Antiviral medications can be used:

1. With episodic treatment, the aim is to shorten the time each outbreak lasts and to relieve symptoms. If you are coping well and your outbreaks are not too frequent, you and your doctor may agree that episodic treatment is the most appropriate option.

2. 'Suppressive' therapy. If your recurrent outbreaks are frequent or severe - or if you find them particularly bothersome - your doctor may recommend that you take oral antiviral medication every day to help prevent outbreaks happening. Suppressive therapy is taken continuously, e.g. daily, for months or even years.

Oral antiviral medication is only available by prescription. If you are taking 'episodic' therapy then the earlier treatment starts after symptoms of an outbreak first appear, the more effective it will be. Ask your doctor to prescribe treatment in advance so that you can self-initiate immediately you detect the early symptoms of a herpes episode.

Recommended Books:

 Genital Herpes Pamphlet

Aciclovir

As episodic treatment, aciclovir should be taken five times a day. Aciclovir can also be used as suppressive treatment to help reduce the number of outbreaks. For suppressive treatment, you will need to take tablets two, three or four times a day.

The side effects of aciclovir are usually mild. They include nausea and diarrhoea.

Picture genital herpes treatment - Aciclovir .

Famciclovir

Famciclovir has been shown to reduce the time that outbreaks last when used as episodic treatment. The severity of pain with outbreaks is also decreased. Like aciclovir, famciclovir also shortens the period during which virus is detected on genital surfaces.

Famciclovir is taken three times a day, when it is used as episodic treatment for the initial genital herpes episode, or two times a day to treat recurrent outbreaks.

Picture genital herpes treatment - Famciclovir.

Famciclovir is approved in some countries for daily use as suppressive therapy. When it is used in this way, it has been shown in clinical trials to increase the time between outbreaks. For suppressive therapy, famciclovir is taken two times every day.

The side-effects of famciclovir are generally mild with headache and nausea being reported.

You should consult your doctor for further information about antiviral treatment for your particular situation.

Valaciclovir

When used as episodic treatment, valaciclovir helps the sores heal faster, and shortens the period of pain during the outbreak. Valaciclovir also reduces the time during which the virus is detected on genital skin surfaces (virus shedding) - a time when the disease can be passed on to a sexual partner.

Picture genital herpes treatment - - Valaciclovir.

If you take valaciclovir as soon as you notice the first signs of an outbreak - such as tingling, itching or redness - you may be able to completely prevent the development of painful blisters. In clinical tests, valaciclovir prevented the development of painful blisters and ulcers in one third more patients who took the drug within 24 hours of noticing the first symptoms of the outbreak, compared to those who took a dummy (placebo).

Valaciclovir is taken twice a day when used as episodic treatment.

In many countries, valaciclovir can be used as 'suppressive' treatment. Clinical trials have proved it to prevent or delay up to 85% of herpes outbreaks. For suppressive treatment, you only need to take valaciclovir once a day, or possibly twice a day if outbreaks are very frequent.

Side effects with valaciclovir are usually mild and may include headache and nausea.

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