Clinical Reference Systems: Pediatric Advisor 10.0

DESCRIPTION (Diagnosis must be confirmed by a physician.)

• About 2 to 14 days after sexual contact with an infected person, a burning sensation, tingling, or itching of the genitals begins.
• Twenty-four to 48 hours later, groups of fluid-filled blisters appear on the genital area. These may become very painful as they turn into ulcers.
• In females sores may appear around and in the vagina, on the cervix, on the thighs and buttocks, or around the anus.
• In males sores appear on the penis, in the urethra (the tube urine passes through), on the thighs and buttocks, or around the anus.
• A sensation of burning may be felt during urination.
• The infection can cause fever, headache, body aches, and swollen lymph glands in the groin.

CAUSE

Genital herpes is one of the most common sexually transmitted diseases. It is caused by a virus called the herpes simplex virus (HSV).

There are two types of herpes simplex infections:

• Herpes simplex virus (HSV) type 1 causes what is commonly known as a cold sore or fever blister around the lips and mouth. Factors that possibly trigger HSV type-1 infections are stress, sunlight, temperature changes, and many different irritants.
• The sexually transmitted herpesvirus is HSV type 2. It is also called genital herpes because it usually causes sores on or near the penis or vagina. Herpes is highly contagious through sexual contact. Herpes can be passed to another person even if there is not an active blister or sore; that is, even when the infected person (the carrier) has no symptoms. For this reason and because herpes sores may be hidden in the internal parts of the genital area or may not be painful, a person may unknowingly infect others.

HSV type-1 infections may also occur in the genital area, and HSV type-2 infections may occur on the mouth. Oral- genital contact is probably how this happens.

Active herpes infection can be transmitted from a mother to her baby during birth. The herpesvirus can enter the baby's bloodstream and sometimes causes permanent brain damage.

EXPECTED COURSE

The sores usually start to heal after about 5 days and generally disappear in 1 to 3 weeks. Sometimes they may last as long as 6 weeks.

Unfortunately, the long-term course of herpes cannot be predicted for any one person. The disease often recurs, with 50% of patients getting the sores again within 6 months after the first appearance of the sores. Symptoms are usually milder in recurring attacks.

TREATMENT

1. Medication and sitz baths

   There is no cure for herpes at this time. Although they may recur, herpes sores do heal by themselves. The following treatment can reduce pain and speed up the healing process:

   • Prescription medication. The following medicines are all forms of a prescription drug called acyclovir. If you start taking one of these medicines within 6 days after the sores appear, you can reduce the pain of the initial infection and speed up the healing process. Your doctor may give you one of the following prescriptions:
     • 400 mg of acyclovir three times a day for 7 to 10 days
     • 200 mg of acyclovir five times a day for 7 to 10 days
     • 250 mg of famciclovir three times a day for 7 to 10 days
     • 1 gram of valacyclovir twice a day for 7 to 10 days.

     Acyclovir may also be used for severe pain in recurrent infections.

     If you are pregnant, discuss the use of acyclovir with your health care provider.

   • Sitz baths two or three times a day in warm water will help soothe the pain.
   • Pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) can help relieve pain and fever.

2. Emotional effects

   Although genital herpes itself is not usually a serious disease, having it can lead to depression and other emotional problems. Don't let herpes lower your self-esteem. Recognize and avoid stress because stress can decrease your resistance to reinfection.

   There are many herpes counseling groups that give support and help to herpes patients. Information can be obtained by contacting the National Sexually Transmitted Disease Hotline at 1-800-227-8922 (a toll-free number).

3. Prevention

   Don't expose others to your herpes. Tell any sexual partners about your infection.

   Both initial and recurrent sores shed virus. Avoid sexual contact while sores are present. Using condoms every time you have sexual intercourse to prevent the spread of herpes can be almost as effective as abstinence (not having intercourse). In addition, you are less likely to get a sexually transmitted disease if you have just one sexual partner.

   Women should have a pelvic exam to find out if they were exposed to any other sexually transmitted disease at the same time as the herpes infection. Every woman (with or without herpes) should schedule a yearly pelvic exam and Pap smear.

CALL YOUR PHYSICIAN DURING OFFICE HOURS IF:

• Your symptoms worsen.
• You have other questions or concerns.