Vidarabine

Definition

Genital herpes is a sexually transmitted disease caused by the herpes simplex virus. The disease is characterized by the formation of fluid-filled, painful blisters in the genital area.

Description

Genital herpes is a sexually transmitted disease spread by vaginal, anal, and oral contact. The first herpes infection a person has is called a primary infection. It develops about four to seven days after contact with the disease. Once a person has been infected with the herpes virus, it cannot be completely cured. Instead, the virus can lay latent in the sensory nerve ganglia for days, months, or even years between outbreaks. When the virus becomes activated there is a recurrent infection of the skin. An active herpes infection is then obvious because of the sores that develop. However, an active infection may occur without visible sores. Up to 75% of people with herpes may not know they have the infection.

Newborn babies who are infected with herpes virus experience a very severe, and possibly fatal, disease called neonatal herpes. In the United States, one in 3,000-5,000 babies born will be infected with herpes virus. Babies usually become infected during passage through the birth canal, but they also can become infected during pregnancy if the membranes rupture early.

Causes & symptoms

Genital herpes results from an infection by herpes simplex virus. There are several different kinds of human herpes viruses. Only two of these, herpes simplex type 1 (HSV-1) and type 2 (HSV-2), can cause herpes. HSV-2 is most often responsible for genital infections. HSV-1 usually causes oral herpes, but it can also cause genital herpes about 10-30% of the time. While the herpes virus can infect anyone, not everyone will show symptoms. Risk factors include early age at first sexual activity, multiple sexual partners, and a medical history of other sexually transmitted diseases (STDs).

The first symptoms of a primary herpes infection usually occur within two to seven days after contact with an infected person but may take up to two weeks. Symptoms of a primary infection are usually more severe than those of recurrent infections. For up to 70% of people, a primary infection causes general symptoms such as tiredness, headache, fever, chills, muscle aches, loss of appetite, and painful, swollen lymph nodes. These symptoms are greatest during the first three to four days of the infection and disappear within a week.

Most people with genital herpes experience prodromes, or symptoms of the oncoming disease. This might entail pain, burning, itching, or tingling at the site on the genital area, legs, or buttocks where blisters will form. The prodrome stage may occur anywhere from a few hours, to one or two days before an outbreak of the infection. Following that, small red bumps appear. These bumps quickly become fluid-filled blisters that may also fill with pus, and become covered with a scab. The blisters may burst and become painful sores. Blisters may continue to erupt for a week or longer. Pain usually subsides within two weeks, and the blisters and sores heal without scarring by three to four weeks. It is possible to pass the virus to other parts of the body by touching an open sore and then bringing the fingers into contact with the mouth, the eyes, or a break in the skin. The highest risk for spreading the herpes virus is the time during the appearance of blisters up to the formation of scabs. However, an infected person can spread herpes virus to other people even in the absence of sores.

Women can experience a very severe and painful primary herpes infection. In addition to the vaginal area, blisters often appear on the clitoris, at the urinary opening, in the rectum and around the anus, and on the buttocks and thighs. The cervix is almost always involved, causing a watery discharge. About one in 10 women get a vaginal yeast infection as a complication of herpes. In men, the herpes blisters usually form on the penis but can also appear on the scrotum, thighs, around the anus, and in the rectum. Men may also have a urinary discharge with a genital herpes infection. Both men and women may experience painful or difficult urination, swelling of the urethra, meningitis, and throat infections, with women experiencing these symptoms more often than men.

It is unknown exactly what triggers a latent herpes virus to activate, but several conditions seem to be connected with the onset of an active infection. These include illness, stress, tiredness, sunlight, menstruation, skin damage, food allergies, and extreme hot or cold temperatures. Most people with genital herpes experience one or more outbreaks per year. About 40% experience six or more outbreaks per year. Active recurrences of herpes are usually less severe than the primary infection. There are fewer blisters, less pain, and the time period from the beginning of symptoms to healing is shorter than the primary infection.

Diagnosis

Because genital herpes is so common, it can be initially diagnosed by symptoms. A Tzanck test can also be used for a quick initial diagnosis. It is performed using a sample scraped from the base of an active blister. A confirmation of the diagnosis can be done by making a tissue culture of material scraped from the skin lesions, testing the blood for herpes antibodies, or examining fluid and scrapings from the lesions by a method called direct immunofluorescent assay. Since most infants infected with the herpes virus are born to mothers with no symptoms of infection, newborns and pregnant women are often routinely given blood tests called the TORCH antibody panel, which includes a test for herpes. Babies also need to be checked for signs of herpes infection in their eyes. Skin sores and sores in the mouth should be sampled for the presence of herpes simplex.

Treatment

An imbalance in the amino acids lysine and arginine is thought to be one contributing factor in herpes virus outbreaks. Supplementation with lysine may help maintain the correct balance and prevent recurrences of herpes. Patients may take 500 mg of lysine daily and increase to 1,000 mg three times a day during an outbreak. Intake of foods that are rich in the amino acid arginine should be avoided, including chocolate, peanuts, almonds, and other nuts and seeds.

Clinical experience indicates a connection between high stress and herpes outbreaks. Many people respond well to stress reduction and relaxation techniques. Acupressure and massage may relieve tiredness and stress. Meditation, yoga, t'ai chi , acupuncture and hypnotherapy can also help relieve stress and promote relaxation. Counseling and support groups are often recommended to deal with the emotional and psychological stress of the disease.

An extract of bovine thymus gland can be taken to improve immune function and help the body fight against viral infections such as herpes. Some herbs are also able to serve as antivirals. They include echinacea and garlic, Allium sativum. Siberian ginseng, Eleutherococcus senticosus, is useful to relieve the stress response that can bring on recurrent herpes outbreaks. Supplementation with beta-carotene and vitamin E is recommended during an outbreak. Homeopathic remedies that may be helpful treatments for genital herpes include Rhus tox 6c and Apis mellifica 6c.

There are traditional Chinese medicine combinations that are useful for herpes outbreaks. One, called Zhi Bai Lui Wai Di Huang, is a mixture of philodendron and other remedies. Another is Long Dan Xie Gan Tang, a soup made to drain the liver. A traditional Chinese medicine practitioner can help create the right combination specific to the outbreak.

Red marine algae, both taken internally and applied topically, is thought to be effective in treating herpes. Other topical treatments may be helpful in inhibiting the growth of the herpes virus, in minimizing the damage it causes, or in helping the sores heal. Zinc may also be used both internally and externally. Oral supplementation coupled with an application of zinc sulfate ointment may help heal sores and fight recurrent outbreaks. Lithium succinate ointment may interfere with viral replication. An ointment made with glycyrrhizinic acid, a component of licorice, Glycyrrhiza glabra, seems to inactivate the virus. Topical applications of vitamin E oil or tea tree oil (Melaleuca spp.) help dry up the sores.

Allopathic treatment

There is no cure for a herpes infection. Aspirin may be used to reduce pain and inflammation. Antiviral drugs are available that may lessen the symptoms and decrease the length of outbreaks. There is evidence that some may also help prevent the spreading of the disease and reduce recurrence of future outbreaks. For the best results, treatment with antiviral drugs has to begin during the prodrome stage, before blisters are visible. Depending on the length of the outbreak, drug treatment may continue for up to 10 days.

Acyclovir (Zovirax) is the drug of choice for herpes infection and can be given intravenously, taken by mouth, or applied directly to sores as an ointment. Intravenous acyclovir is given to patients who require hospitalization, usually due to severe primary infections or complications of herpes such as aseptic meningitis or sacral ganglionitis, an inflammation of nerve bundles. Acyclovir reduces the virus shedding period, the duration of the blisters, and the healing time. Patients with herpes outbreaks happening more often than six to eight per year may be given a long-term course of treatment with acyclovir. This is referred to as suppressive therapy. Patients on suppressive therapy have longer periods between herpes outbreaks. Alternatively, patients may use short-term suppressive therapy to lessen the chance of developing an active infection during special occasions such as weddings or holidays. Side effects of acyclovir include nausea, vomiting, itchy rash, and hives. Other drugs that may be used include famciclovir (Famvir), valacyclovir (Valtrex), vidarabine (Vira-A), idoxuridine (Herplex Liquifilm, Stoxil), trifluorothymidine (Viroptic), and penciclovir (Denavir).

Neonatal herpes is a serious condition. Even with treatment, babies may not survive or they may suffer serious damage to the nervous system. Newborns with herpes infections are normally treated with intravenous acyclovir or vidarabine for 10 days. However, infected babies may have to be treated with long-term suppressive therapy. These drugs have greatly reduced deaths and have also increased the number of babies who are relatively healthy by one year of age.

Expected results

Genital herpes is usually not a serious disease, with several major exceptions. Sometimes, a primary infection can be severe and may require hospitalization for treatment. Complications that may arise include aseptic meningitis and nervous system damage. There may also be constipation, impotence, and difficulty with urination. In addition, people who are immunosuppressed due to disease or medication are at risk for a very severe, and possibly fatal, herpes infection. And even with antiviral treatment, neonatal herpes infections can be fatal or cause permanent nervous system damage.

Prevention

The only way to definitely prevent a genital herpes infection is to avoid contact with infected people. This is not an easy solution because many people aren't aware that they are infected. Use of condoms and spermicidal jellies or foams with nonoxynol-9 is recommended with all partners whose disease status is questionable or unknown. However, condoms may not protect against herpes when there is skin contact with someone with an open sore that cannot be covered by a condom. Use of dental dams or squares of non-microwaveable plastic wrap is also recommended. Sexual contact should be avoided altogether during a herpes outbreak. Touching affected areas should be avoided, since this can spread the infection to other sites. In order to prevent a child from contracting a herpes infection through contact in the birth canal, doctors usually perform Caesarean sections on women who have active herpes sores when they go into labor.

Key Terms

Culture

A laboratory test in which colonies of microorganisms are grown from tissue samples of an infected individual in order to identify the pathogen.

Immunofluorescent assay

A laboratory technique using a fluorescent dye and a special microscope to identify the cause of an infection.

Meningitis

An infection or inflammation of membranes of the brain and spinal cord.

Sensory root ganglion

A bundle of nerves that help conduct physical sensations.

Tzanck test

A laboratory test using a microscope to examine tissue samples that have been stained with certain dyes.

Urethra

The small tube that drains urine from the bladder.

Further Reading

For Your Information

Books

• Ebel, Charles. Managing Herpes: How to Live and Love With a Chronic STD. Durham, NC: American Social Health Association, 1998.
• Sacks, Stephen L. The Truth About Herpes. Seattle: Gordon Soules Book Publisher, 1997.

Periodicals

• Murray, N.D., Michael T. "Natural Help for Herpes and Cold Sores." Let's Live (April 1997).

Other

• drkoop.com, Inc. http://www.drkoop.com/conditions/sexual_health/page_59_277.asp.
• Merck & Co., Inc. The Merck Manual Online. http://www.merck.com/pubs/mmanual/section13/chapter164/164k.htm.
• Mother Nature.com. http://www.mothernature.com/ ency/homeo/ herpes_simplex_hm.asp.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.