Genital, or venereal, herpes is a highly contagious viral infection of the male and female genitalia. Unlike other STDs, genital herpes tends to recur spontaneously. The disease has two stages. During the active stage, characteristic skin lesions and other accompanying symptoms may occur. During the latent stage, the individual is asymptomatic. The incidence of genital herpes is beginning to decline, but at least 45 million individuals ages 12 and older have genital herpes.
Genital herpes is caused by the herpes simplex virus (HSV). Two strains of the virus—designated HSV-1 and HSV-2—may produce the disease. Most cases of genital herpes, however, are attributable to HSV-2. The disease is transmitted through direct contact with infected bodily secretions. Infection typically occurs during sexual intercourse, oral-genital sexual activity, kissing, and handto-body contact. A particularly life-threatening form of the disease can occur in infants infected by the virus during vaginal birth.
Signs and Symptoms
During the active phase of the disease, males and females may present with characteristic skin lesions on their genitals, mouth, and/or anus (see Fig. 16.5). These appear as multiple, shallow ulcerations, pustules, or erythematous vesicles. The diffuse redness of the skin, or erythema, is caused by dilation of the superficial capillaries. The vesicles tend to rupture, causing acute pain and consequent itching. Other generalized symptoms may include fever, headache, malaise, muscle pain, anorexia, and dysuria. Leukorrhea may be a further symptom in females.
Physical examination for evidence of the characteristic lesions is usually sufficient for diagnosis. Scraping and biopsy of the ulceration with evidence of HSV-2 may be required to confirm the diagnosis. Blood tests can detect antibodies to HSV-1 or HSV-2.
Acyclovir is an effective treatment for genital herpes. Newer agents include famciclovir and valacyclovir. These drugs will not eradicate the virus, but when taken as soon as an outbreak occurs, they can shut down virus production. Secondary infections need to be prevented or speedily managed. Topical medications may be ordered to reduce edema and pain. Clients are encouraged to keep lesions clean and dry.
FIGURE. Genital herpes on the glans penis and penile shaft. (Centers for Disease Control and Prevention. Dr. N. J. Flumara and Dr. Gavin Hart, 1976.)
Complementary therapy aims to diminish discomfort and hasten recovery. An ice pack applied to sores at the beginning of eruptions can help. Cool compressions or baking soda also soothes lesions. A topical cream made from the Prunella vulgaris plant has shown promise in reducing skin lesions.
Clients may be embarrassed about their disease; reassure them that they can lead a sexually healthy life so long as they adhere to proper precautions.
Genital herpes cannot be cured. The prognosis varies according to the individual’s age, the severity of the infection, the promptness of treatment, and the individual’s immunological response. It is estimated that as many as 80% of individuals with primary genital herpes infections will experience a recurrence within 12 months. The virus is also associated with cervical cancer.
No proven method of prevention among adults has been established other than avoiding sexual intercourse and other sexually intimate contact with infected individuals when lesions or symptoms of herpes are present and using condoms during all sexual exposure. Transmission of the disease to neonates can be minimized through cesarean delivery when it is known that the mother is infected.