Herpes genital 253

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Cause

Herpes simplex virus type II causes 85 percent of genital herpes cases. Type I, which causes most herpes infections above the waist, is responsible for the other 15 percent. The infection is spread by contact with the genital secretions of a person with an active lesion. It is possible, however, for a person with no active lesion to shed virus and infect a sex partner.

The virus can infect any skin or mucous membrane surface on the body. For example, a person with a cold sore who engages in oral sex can transmit genital herpes to a partner.

"Neonatal herpes" is the term for a herpes infection in newborns that is acquired from an infected mother during birth.

Symptoms

Only about 40 percent of patients with herpes ever have symptoms. When they do, the first appearance of herpes lesions is the worst, with many painful lesions lasting up to 10 days; it may take two to three weeks to completely recover from this first attack. When the sores fade away, the virus remains behind. The virus is now latent. During the first attack, some people have a generalized sick feeling, with swollen glands in the pelvic area and fever, fatigue, headache, muscle ache, and nausea. people with no antibodies to herpes type I (cold sores) usually will be sicker during a first attack. Girls usually have lesions on the cervix or vulva, with recurrences on the vulva, the skin between vagina and anus, upper thighs, anal area, or buttocks. Boys have lesions on the head or shaft of the penis and the anus.

Most people have a recurrence within six months of their first attack that begins with a tingling, itching, or prickling sensation in the area where the virus entered the body. This is followed in a few days by a raised cluster of small painful blisters; there may be several groups of blisters. Eventually, the sores will crust over and dry up. Most people do not have the generalized sick feeling with recurrent infections.

patients are infectious until the sores heal completely, usually up to 12 days; recurrent infections usually remain infectious for up to a week. Recent studies have shown that it is quite possible to shed virus without symptoms, which is how it is possible to infect a partner when no sores are present.

Neonatal herpes can take many different forms. About one-third of affected babies will have skin, eyes, or mouth lesions before any other symptoms; another third will have a brain infection (encephalitis), pneumonia, or infection of other organs; and the final third will have symptoms of both types. Respiratory distress, fever, skin lesions, or convulsions are common herpes symptoms in newborns.

Diagnosis

Doctors may diagnose genital herpes by symptoms alone, but there are also several lab tests that can confirm the infection. A specimen from the base of a lesion can identify the type of cell. Herpes also grows rapidly in tissue culture; specimens from a new lesion can be identified within 48 hours in the lab. Blood tests can look for antibodies to herpes; the newest blood tests can tell the difference between type I and II.

Treatment

The antiviral drug acyclovir (Zovirax) became available in the 1980s to treat herpes, but it is not a cure, since it does not kill the virus. However, it can significantly reduce the severity of symptoms. Available in ointment, capsule, liquid, and intravenous (Iv) forms, capsules are usually used to treat primary genital herpes or a severe recurrence, or to suppress a frequent recurrence. Taking acy-clovir at the first sign of a recurrence—that is, during the tingling phase before lesions begin—can shorten the healing time from four or five days to one day.

people with more than six recurrences in a year can take daily acyclovir to prevent recurrence. Most patients do not take acyclovir for more than three years. very few people report side effects with this drug.

Intravenous acyclovir is given for severe primary herpes for hospitalized patients, and for babies born with or exposed to herpes during birth.

Symptoms can be eased with frequent sitz baths in lukewarm water. A small amount of petroleum jelly on the sores can reduce the irritation during urination. very painful sores may be eased with an anesthetic ointment. While sores are present, girls

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