A RECURRENT, often painful sexually transmitted disease, genital herpes is caused by herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most cases of genital herpes are caused by HSV-2. However, HSV-1, which commonly manifests as fever blisters or cold sores in the mouth and on the lips, can be transmitted through oral sex from the lips of one partner to the genitalia of another, and vice versa.
Rarely, herpes is transmitted to newborns during vaginal deliveries and can lead to potentially fatal infections in infants.1 Pregnant women who are experiencing an outbreak of genital herpes near delivery may be advised to have a cesarean section to prevent transmission to the newborn.1,2 Affecting about one out of six people in the United States, genital herpes is infectious and incurable.1
Signs and symptoms
Most patients with genital herpes are asymptomatic.1 The incubation period for herpes is 7 to 14 days after exposure. A herpes infection may present as blisters on the labia, vagina, cervix, thighs, buttocks, and anus in females and the penis, scrotum, thighs, buttocks, and anus in males. Herpes can infect any part of the body, including the mouth, throat, lips, eyes, and fingers.
Some patients with genital herpes experience fever, chills, myalgia, malaise, dysuria, and anorexia. A patient may experience paresthesias and pruritus before painful, clear, or straw-colored fluid-filled blisters appear. Within a few days the blisters break, leaving a small but painful ulcer that crusts over a day or two later. Some infected patients report a series of blisters during the initial outbreak, which may last for 2 to 4 weeks.
After the initial infection, HSV retreats to nerve cell ganglia near the infection site and becomes latent. In response to various stimuli, it reactivates, causing new outbreaks.3
Men tend to have fewer outbreaks than women. Immunocompromised individuals can have more severe symptoms.1,2
An outbreak may be triggered by stress, fatigue, menstruation, illness, immunosuppression, or friction at the site. When conditions are right, the virus replicates and migrates along the neuron to the skin's surface. This may cause paresthesias along dermatomes. Mild analgesics and sitz baths relieve pain. Over time, outbreaks typically decrease in number and severity.
Serological testing may be done to identify HSV-1 or HSV-2 antibodies. To definitively diagnose herpes, blister exudate is collected for lab testing to identify the virus. Viral counts decrease once blisters have broken open, so it's recommended to swab or scrape a fresh blister rather than culture exudate from an ulcer.1,2
Treatment and teaching
A patient presenting with an initial outbreak of herpes or recurrent outbreaks is usually prescribed antiviral drugs such as acyclovir, famciclovir, and valacyclovir. These drugs don't cure the disease but can lessen pain and decrease the severity and duration of the outbreak.
Patient education is the best method for combating the spread of herpes. Teach patients that:
- herpes is transmitted through contact with persons infected with HSV.
- herpes may be transmitted with or without blisters.
- antivirals don't cure or prevent herpes; they just reduce symptoms.
- latex condoms reduce the risk of herpes transmission.
- past, current, and future partners should be informed of the potential for infection, whether or not the patient is experiencing an outbreak.
- the patient should abstain from sexual activity if an outbreak is imminent and during an outbreak until all lesions are completely healed.
- immunosuppressed people are at a higher risk of contracting herpes.
Instruct patients to gently clean the infected areas with mild soap and water, gently pat dry the area, and avoid reusing towels on other areas of the body such as the face and eyes. Advise them to thoroughly wash their hands after cleaning the infected area, and to wear cotton undergarments.
Herpes can cause psychological distress, so advise patients a diagnosis of genital herpes has a very good prognosis with few complications. Provide information on counseling and support groups in their area.