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Herpes Genitalis- takes the fun out of sex, If there is one sexually transmitted disease that is not fun to have, it is genital herpes. Over the last 2 decades, millions have been infected with this virus and it has created hysteria and havoc in social and personal relationships. There are more myths surrounding this infection than any other disorder. Herpes simplex type 2 is the cause of genital infection. The infection is common world wide and affects both males and females equally. You see, herpes simplex 2 has a tendency to affect both the anal area and the genitals. Recent data indicate that this is not a rigid rule and the virus also infects the mouth area- in those who practice oral sex. Once acquired, this virus never goes away. It stays inside the body and brings about an infection again and again- herpes forever.

Classification

Herpes infections are typically classified as primary or recurrent. The primary infection is usually acquired during childhood. In some individuals, there may be only episode of infection (primary); for the unlucky individual, the virus keeps on reactivating itself and causes repeat infections (secondary). After the first infection, the virus never disappears from the body. One of the oddities about herpes infections is that the organism has a great affinity for nervous tissue- and this is where it resides (latent or goes to sleep). The secondary infections occur when the virus is reactivated from its dormant state and causes the infection. Why and what makes the virus active again is a mystery but some factors are known to trigger its reactivation. These include stress both physical and emotional, excessive exposure to sun, major illness, colds, fevers and a lot of bad luck.

Signs and Symptoms

Unlike what everyone thinks, not all herpes infections are associated with symptoms. A significant number of individuals have no symptoms at all and never even know they have a herpetic infection. Despite the fact these individuals have no signs or symptoms of an infection; they all have the capability of transmitting the infection to their partners. Most people who acquire genital herpes get it from a partner who have no symptoms. It is doubtful if anyone sane would have any type of a sexual activity with a partner in the presence of full blown herpes infection. In fact, in the presence of an active infection, the carrier himself would not have the desire to have sex with anyone. In men, the herpetic lesions are most common near the tip of the penis. A few individual do develop the blisters on the shaft of the penis. In those who engage in anal intercourse, the blisters can occur around the entire anus. Lesions around the buttocks are also common. In women, the lesions are most common on the inside of the labia and cervix. However, the lesions may occur anywhere on the inside or outside of the vagina. Herpes simplex has a fairly standard presentation. Those who become symptomatic from the infection never forget the episode and dread the beast. The symptoms usually arise 2-3 days after acquiring the infection. Most individuals will have an odd feeling, burning, tingling, pain or an odd ache in the genital area. A few days later, painful blisters will become prominent around the penis or vagina. The number of blisters is variable but most have at least a couple. The pain is sharp and burning in nature. Many an individual has required admission for pain control from a herpetic genital infection. The sores are tender to touch and even urination is painful. In those who are liberal in their sex life and acquire an anal infection, the feeling is like a hot burning dildo placed in the arse- infact quite painful and pooping is almost impossible. Any thoughts of eroticism and sexual intercourse are always absent because of the pain. For the men, the blisters occurs at the tip of the penis and cause difficulty with urination and even tight undergarments can be very uncomfortable. Almost all genital blisters turn into open ulcers after few days. The soreness does diminish a little but the general ill health does continue. After about 7-10 days, the ulcers dry up and become crusted and fall off. The entire episode can last 7-12 days. After the initial infection, the virus disappears and goes into a latent stage and may never again cause an infection.

Primary herpes genitalis

In all cases, the first episode is the most painful and hard to forget. The initial episode is always the longest in duration and is also associated with extra genital symptoms (fever, malaise, general wear down of the body, depression). The initial infection is generally 10-14 days in duration after exposure to the virus. For most individual the agony does not simply end there. The other symptoms of fatigue, tiredness and anxiety can take a few more weeks to subside. A few individuals may develop a long lasting syndrome of pain known as post herpetic neuralgia (which is difficult to treat). However, even when the blister has disappeared and all the symptoms resolved, the virus unfortunately goes into hiding. The virus has a great tendency to reside in nerve tissues, where it remains silent.

Recurrence

After the onset of an infection, the virus has a great affinity for nerves tissue and hides there (becomes latent). For some individuals there may be just one infection from the virus- just for remembrance- for the unlucky ones, the infection may be recurrent. Secondary herpes is due to a local reactivation of the virus. Why some individual get just one infection and why other get recurrence is a medical mystery. A number of individual keep on getting recurrent herpes sores. As to why some individuals get it and some do not, is a medical mystery. But we do know that some conditions can increase the chance of recurrence. The recurrence may be in the same location around the genitalis or in a different site. The recurrence rate is variable. There may be one recurrence a month, or several a month or once a year. The signs and symptoms of recurrent episodes are generally less severe. Most individuals have a prodrome (an impending sense) when the recurrence will occur. These prodrome symptoms may include the onset of tingling, pain, itching or an unusual feeling around the genitalia area (the unusual feeling is never good).

Diagnosis

In most cases, the diagnosis of herpes genitalis is obvious. To confirm the diagnosis, swabs from the genitalia will be obtained. The virus is generally discovered only during the presence of the blisters. In most cases, the virus is never found. The use of blood to detect antibodies towards the herpes virus is not sensitive and rarely done. One reason why the diagnosis is confirmed for the genital herpes virus is that in many cases, there may be another sexually transmitted disease present. In as many as 20% of individuals with a sexually transmitted disease, another organism is always found and may require treatment.

Sexual relationships

Individual who have genital herpes have a dilemma with their partner. Telling a partner about a herpes infection is always a Taboo and may end the relationship. The social stigma associated with sexually transmitted disease is always negative. Whether to tell the partner about the infection requires courage, honesty. One may not tell and live with the guilt. However, the risk of spread and recurrence is very high in situations where one partner remains ignorant. Because most individuals do not understand herpetic genitalia infection, the sexual intimacy may always be surrounded by confusion and difficulty with long term relationship. Whether the partner is told or not, the use of a condom is greatly encouraged. In addition, anti viral drugs may be another alternative and have to be taken daily (would be very hard to explain to a partner why one is taking the medications if the partner has not been told about the infection).

Management

General Care: The first thing to do is avoid physical contact with individuals who have an active infection. Hand washing is a key aspect of preventive care. General hygiene is the key to preventing transmission of the disease. There are numerous solutions and ointments which can be applied on the genitalia. Some even recommend a local anesthetic solution. Viscous anesthetic creams and ointments are available and may help decrease the pain. One should refrain from rubbing the eye with the fingers so as not to infect the eye. All activities with another partner which involve the mouth or genital organs should be avoided. Genital herpes, in either parent, does not generally affect children and there is little risk of transmission so long as normal hygiene is practiced. Genital herpes can be acquired not only with genital contact but also with oral manipulation. Medications The pain can vary in intensity and most individuals require pain control. Over the counter pain medications are effective for most individuals but some may require much stronger prescription pain pills. One should never apply any cortisone to the infected area. Cortisone encourages the virus growth and makes the condition worse. Antiviral Therapy The best and most effective treatment of genital herpes is antiviral medication. The anti viral drugs stop the virus from multiplying. The drugs can shorten the duration of a herpes outbreak and reduce the number of repeat infections. Unfortunately, the drugs only work if taken continuously. This may not be practical and cost effective. For those who have an acute infection, the antiviral medication can reduce the number of days the infection is present. This is very helpful to those who have been plagued with painful blisters. There is a topical antiviral drug available. IT is best thrown away. The topical medication is essentially useless and only reduces the infection duration for a day or two and costs a fortune. For those who have recurrent infections, the anti viral drugs have to be taken everyday. This is expensive and not practical. The anti viral medications available today all require a prescription. The current antiviral drugs available to treat type 2 herpes simplex include: - Acyclovir (Zovirax) - Famciclovir (Famvir) - Valacyclovir (Valtrex) Acyclovir is probably the best and most effective. It comes as a topical cream and a pill. The topical cream is expensive and useless. It is a complete waste of one’s money. It only reduces the infective period by a day or two at most. The oral pill is effective and decrease the duration of infection and recurrences. However, it has to be taken 5 times a day, for 10 days and costs a fortune. Oral anti-viral medications such as famciclovir or valacyclovir have been developed to effectively treat herpes infections. These medications can be used to treat the acute infection or may be used to prevent recurrences. Unlike acyclovir, these medications are generally used in the sick patients who have other illnesses. The drugs are fairly expensive. Alternative therapy Like most things in medicine, patients rapidly become dis-satisfied with conventional treatment- everyone wants instant relief and Nirvana- and when this fails they seek alternative care. The alternative health care business is flourishing even without the back up of any scientific data. The reason is patient gullibility because of the false claims made by this industry. Every type of nutritive and herbal agent has been postulated to help cure herpes. From mega doses of all vitamins, minerals to gouging on the liver, spleen, thymus of cows, chickens and pigs. Hundreds of herbs are sold as a remedy for herpes-teas, powders, capsules of every kind are sold- some are recommended to be taken in orally, some to be pasted on the lips and some to placed in the rectum (it sure is a medical miracle if a rectally placed herb can cure an infection in the mouth) - yet millions of people buy and use these products Other therapies that have been used to treat herpes include acupuncture, psychological therapy, behavioral counseling and massage therapy,

Legal implication

Anyone diagnosed with genital herpes must disclose the diagnosis with their sexual partner(s). In many States, this is mandated by law and the punishment is severe for individuals who are ignorant of this warning. Herpes genitalis has implications beyond medicine. All partners should seek medical attention to ensure they have not contracted a sexually transmitted disorder. For those who have no symptoms, watchful waiting is the best management

Prevention

People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. The condom is not full proof during active herpes because there may be some sores not covered by the condom or the condom may fall off (either the condom is too big or dick is huge). Although the chance of spreading disease is greatest when sores are present, people who have had genital herpes should always be assumed to be contagious, even if they are on antiviral medication. The virus is easily transferred to the sexual partner even when the skin appears completely normal. The use of a condom should not be underestimated. It is the key to prevention of not only herpes but many other sexually transmitted diseases. During the acute infection, fingering different parts of one’s or the partner’s body is an absolute no-no.

Coping

Many individuals need help to cope with herpes. The type of therapies available include herpes anonymous, self help groups, meditation, yoga, acupuncture, behavior and psychological therapy. The most important is that the individual understand his disease and its course. One can learn how to avoid triggering the infection. Antiviral therapy is available to reduce the outbreak frequency, but the medications are expensive. A positive attitude and knowing that the disease is not lethal will help cope with the disorder.

Prognosis

Most individuals recover from the infection in 7-14 days. The few lucky individuals just get one infection for remembrance. The unlucky ones get recurrences at variable rates. As far as a cure is concerned, it is still several years away and it definitely won’t come cheap. The drug industry is not in the business of losing money. If the price of acyclovir is anything to go buy, the vaccine will definitely not be cheap. There is no doubt that conventional medical therapy has not been very effective in treating herpes simplex. However, it does offer drug therapy (Acyclovir) which is still the most effective compared to whatever else is available. Alternative care may work in some but in most individuals it does not. Herpes unfortunately is forever and so buyer beware of anyone making claims that they can cure it. The best way to cure herpes genitalis is to avoid sex.

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