Years ago, a distressed female client visited me with a prescription. She had noticed the development of painful blisters on her genitals and had visited her doctor who diagnosed genital herpes. She had contracted it from her female partner whom she said had 'cold sores' on her lips.
The client was bitter about the fact that she would have this infection for life and that she would need to declare it to any future mates. She was worried about future flare-ups of this painful, uncomfortable condition. I reassured her that the first outbreak is usually the most severe.
A diagnosis of genital herpes can be traumatic. Genital herpes, like HIV/ AIDS, affects heterosexuals and homosexuals. It is caused by the herpes simplex virus: herpes simplex, type 1 (HSV-1) or herpes simplex, type 2 (HSV-2).
HSV-1 is commonly associated with infections of the lips and mouth, but it can cause genital herpes. It is contracted mainly in childhood from close personal contact with an infected person. Most adults have the HSV-1 virus but do not show signs and symptoms.
Oral-genital or genital-genital contact with an HSV-1 infected person can cause HSV-1 infection of the genitals. Some 10-15 per cent of genital herpes cases are due to HSV-1. Apart from oral and genital sores, HSV-1 can cause serious complications like brain or eye inflammation with tissue destruction.
HSV-2 is sexually transmitted. Symptoms include flu-like symptoms with blisters or sores on or around the genitals or anus, buttocks and thighs. Like HSV-1, some people have HSV-2 but do not show symptoms.
Cross-infection of HSV-1 and HSV-2 may occur from contact between the lips and the genitals. Both viruses are usually transmitted by contact with a herpetic sore through kissing or touching, but transmission can be more complicated, since HSV-1 and HSV-2 can be shed from persons who do not have active sores. So persons who do not know that they are infected may pass on the virus.
Respiratory infections which cause fever can trigger outbreaks of herpes symptoms, hence the terms 'cold sore' or 'fever blister'. Other triggers include physical or psychological stress, injury to the face, surgery, wind, ultraviolet light, sunburn or even menstruation.
Pregnant women with active genital herpes infection at delivery are given Caesarian section since the disease may lead to potentially fatal infections in the baby.
Use latex condoms
Prevention or lowering the risk of genital herpes transmission is possible by methods like abstaining from sexual activities, especially in the presence of open sores, or using latex condoms for sex. Persons with active sores should avoid contact with newborns, children with eczema, and persons with a weakened immune system (e.g. persons with HIV/AIDS). These groups are more likely to be severely affected.
Treatment
There is no cure for genital herpes. It is treated with antiviral drugs, which reduce the severity and duration of an outbreak. The relatively expensive drugs acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) are used. These drugs are effective in reducing the pain associated with genital herpes and may help the sores heal faster. They are taken by mouth, applied to the skin and, in exceptional circumstances, given by injection. For maximum benefit, treatment should be started at the first sign or symptom or within 24 hours.
The antivirals may be used to treat attacks of genital herpes and to prevent flare-ups. Daily maintenance therapy with famciclovir or valaciclovir is given to persons who have more than six flare-ups per year or to suppress the virus and help reduce transmission to partners.
Prevention is better especially when there is no cure.
Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.
