Genital Herpes Recurrent Infections

1. Genital Herpes Recurrent Infections

2. What is Genital Herpes? • Sexually transmitted infection caused by a virus • Common signs and symptoms of initial infection • Small blisters and/or ulcers in the genital area, buttocks, or anus, or the lip and mouth area. • Pain in the genital area or area of blisters/ulcers • Painful urination • Also may cause flu-like symptoms, such as fever and body aches, headaches, and swollen lymph nodes 2-7 days after exposure. • Virus remains in the body for life and outbreaks can reoccur

3. Genital Herpes • Second most common sexually transmitted infection in US according to the CDC (The most common is HPV) • 2 types: herpes simplex virus (HSV-1 and HSV-2) • In the past HSV-1 associated with cold sores • HSV-2 was associated with genital lesions • Approx. 50 million people infected with HSV-2 • About 1 in 6 Americans age 14 - 49 is infected with HSV-2

4. How is Herpes Diagnosed? • In symptomatic patients, characteristic blisters or ulcers in genital or oral areas • In asymptomatic patients, blood tests may sometimes be useful to confirm diagnosis, though a positive test can show an infection that occurred many months or years ago. • Harger JH. 2000. In: Mead PB, et al.

5. Genital Herpes • HSV-1 is an increasingly important cause of genital herpes in industrialized countries. • In a large study, younger women ages 18 – 22 • were more likely to become infected with HSV-1, than HSV-2. • HSV-1 appeared 3x more often in the genital area than HSV-2 in this population • Two potential reasons for increase in HPV-1 in young people. • Decrease in HPV-1 exposure in childhood • Increase in oral-genital sex in young people

6. Herpes Ulcers Tip of Penis

7. Herpes Ulcers Labia Vaginal Opening

8. How Do I Get Genital Herpes? • Mainly direct contact with infected secretionsthrough oral, anal, or vaginal sex 1 • Usually, HSV-1 transmitted by oral route and HSV-2 by genital route • Most people who are infected are unaware that they are carrying the infection.2 • Sores may be too small to recognize • Transmission occurs frequently even in absence of visible lesions1,2

9. How Do I Get Herpes? (cont) • About 90% of persons who shed the HSV-2 virus have no history of genital herpes1,2 • Oral sex with a person with oral herpes may resultin genital herpes in the partner3 • Can be transmitted from mother-to-child during delivery4 • Corey L, Handsfield HH. 2000. JAMA. • Corey L, Wald A. 2000. In: Holmes KK, et al. 3. Hirsch MS. 2003. In: Dale DC. 4. Brunton S. 2002. Medscape.

10. Clinical Spectrum of HSV-2 Source: Ashley RL, Wald A. 1999. Clin Microbiol Rev.

11. Who is most susceptible to Genital Herpes Infections • Women are more susceptible than men to genital herpes infections with both HSV-1 and HSV-21,2 • Younger women (18 -22) are more likely to have HSV-1 genital herpes than older women.3 • Black women have the highest prevalence rate of HSV-2.2 • Lifetime number of sex partners increases prevalence.4 • Can be transmitted from mother-to-child during delivery5 .

12. Other Effects of HSV-1 and 2 • HSV primarily effects the nervous system, rather than the skin. • If the central nervous system is infected, it can cause HSV encephalitis (potentially fatal). • If the trigeminal nerve is infected, it can cause cold sores or eye infections. • If the neck region or thoracic sensory nerves are infected herpetic whitlow can result. (finger) • In genital herpes the lumbosacral sensory nerves are infected.

13. How Often Does it Recur? • More than 90% infected with HSV-2 have recurrence during first year1 • Recurrences are less frequent (20%-40%) for oral herpes (mainly by HSV-1)2 • 25%--50% of eye infections with HSV recur within2 years2

14. Link Between HSV and HIV • Genital herpes infection increases the risk of acquiring HIV 2 – 3 - fold. • Genital herpes infection increases the risk of transmitting HIV infection 4 – fold.

15. How is Herpes Treated? • There is no cure for herpes • Antiviral drugs reduce the duration of lesions and viral shedding but do not eliminate the infection1 • Genital herpes patients who are experiencing chronic stress should consider also being treated for their stress to help prevent breakouts.2

16. How Does Herpes Affect Newborns? • Neonatal herpes -- Results from transmission from mother to infant and can be either HSV-1 or HSV-2 • If mother is recently infected, 30%-50% of vaginally delivered infants become infected1 • If mother has a recurrence of herpes during pregnancy, <8% newborns become infected1 • Watts DH, et al. 2003. Am J Obstet Gynecol.

17. How Does Herpes Affect Newborns? (cont) • 1 in 3,200 live births are affected with an estimated 1,500 cases per year.1 • 50% cases of newborn infection occur to mothers with no known history of genital infection2 • If untreated, causes death or brain damagein babies3 • So it is important that a pregnant woman inform her doctor is she or her husband might have herpes or have had it in the past.

18. Reducing Herpes Risk • An effective vaccine has not yet been developed1 • There is some evidence of risk reduction with condom use, but only if used 100% of the time.2,3 • Health workers should wear gloves • Awareness of status5

19. Avoiding Herpes • For unmarried individuals, sexual abstinence is the only practical and certain way to avoid herpes • For those who choose to be sexually active, a marriage (mutually faithful, life-long relationship with an uninfected sexual partner) is the healthiest choice