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The incidence of active genital herpes is difficult to determine precisely because many cases present mild symptoms, are self-limiting, and are not called to the attention of health care personnel. However, it is clear that the disease has reached epidemic proportions in the United States. It is highly contagious and is transmitted by direct person-to-person contact (not limited to sexual contact). Autoinoculation via the hands is possible; for example, from a lip ulcer to the genital area or from the lip or genitals to the eye. Once the virus gains access to the body it enters the nervous system and invades nerve cells located near the site of infection, such as in the sacral ganglia. The virus lies dormant in nerve cells and can remain there indefinitely, predisposing the person to recurrent outbreaks. Factors contributing to recurrent genital herpes are not well understood. Some infected persons experience no recurrences while others have frequent and severe outbreaks. Many patients are aware of a correlation between the appearance of lesions and precipitating factors such as exposure to sunlight, local trauma, fever, or emotional stress. Hormonal changes preceding menses have been associated with recurrences in women.
Typically, recurrent episodes become milder and less frequent; however, some patients may experience weekly or monthly outbreaks that are severe and painful. Those with recurrent herpes usually have high antibody titers. Paradoxically, it has been noted that the higher the antibody titer the more severe the symptoms and the more frequent the recurrences. Thus, it is apparent that the body's immune system is not effective in providing protection against herpes infection or in mitigating its effects.
A genital rash and mild itching usually are the earliest signs of infection. Eventually vesicles on the surface of the skin form, and then enlarge, break open, and ulcerate. The lesions are painful, especially during coitus, and can cause intense itching, and, if the urethra is involved, painful urination. The disease affects both sexes. In the male, vesicles are found principally on the glans penis, shaft of the penis, and prepuce, and may extend to the scrotum and inner thighs. In the female, vesicular eruptions usually involve the vulva, vagina, and cervix, and may extend to the perineum, inner thighs, and buttocks. Lesions of the cervix can vary from small superficial ulcers with diffuse inflammation to a single, large, necrotic ulcer. Other symptoms include malaise, fever, and anorexia. There also can be involvement of neural structures and the manifestation of neurologic symptoms. The characteristic lesions usually last from one to three weeks in either the initial stage or during periodic outbreaks.
Support groups can provide patients opportunities to ventilate their anger and talk about their guilt. In a group of persons with similar problems, they can learn that there are others who have had much the same feelings and have managed to work through them and develop a more positive attitude. The American Social Health Association (ASHA) sponsors self-help groups and provides educational materials; their address is P.O. Box 13827, Research Triangle Park, NC 27709.
Fear of cancer is very real in these patients; females are encouraged to have a Pap smear every six months. Early detection is almost guaranteed with such frequent examinations, and the cure rate in these cases is 100 per cent. Another source of anxiety for female patients is the effect of herpes on fertility and the welfare of infants born of mothers with herpes (see maternal herpes).
Protective measures such as cesarean section for delivery improve the chances of avoiding infection in the newborn. During the last trimester it is best if the woman abstains from sexual intercourse if there is any history of either partner having herpes. When there is such a history, it is recommended that frequent cervical viral cultures be done to determine whether vaginal delivery is safe.
With early diagnosis and cesarean section many infants can be protected from infection, but only if the membranes are intact or have been ruptured no more than 4 to 6 hours before the operation. After that length of time it is assumed that an ascending infection has reached the fetus. Mothers who have no active lesions at the time of birth and two negative cervical smears for the virus within a week of delivery can safely deliver their newborns vaginally.
Wound and skin precautions are followed in the care of the mother if she has recurrent herpes (see above). An isolation nursery and wound/skin precautions are recommended for newborns delivered (whether vaginally or by cesarean section) to women with active genital herpes. Some authorities recommend isolation precautions the entire time the newborn is in the hospital and until the incubation period of 21 days has passed.
Treatment is symptomatic and is aimed at relieving the pain and itching of the blisters. Local applications of calamine lotion or other lotions to dry the blisters may help. Herpes zoster is a very exhausting disease, especially for elderly people, because the constant itching and pain are difficult to control, even with systemic analgesics in some cases.
Herpes zoster affecting the eye causes severe conjunctivitis and possible ulceration and scarring of the cornea if not treated successfully.
Herpes zoster is a communicable disease and therefore requires some type of isolation, the specific precautions depending on whether the disease is localized or disseminated and also on the condition of the patient. Localized lesions in immunocompromised patients often become disseminated. Persons susceptible to varicella-zoster (chickenpox) should stay out of the patient's room. This includes hospital personnel as well as other patients. If there is any question as to the proper procedures for prevention of the spread of herpes zoster, the CDC Guidelines for Infection Control in Hospital Personnel should be consulted.
her·pes sim·plex(hĕrpēz simpleks)
Synonym(s): herpes facialis, herpes febrilis, herpes labialis, Simplexvirus.
her·pes la·bi·a·lis(hĕr'pēz lā-bē-ā'lis)
Synonym(s): fever blister.
Patient discussion about herpes labialis
Q. Are cold sores contagious? My boyfriend has cold sores on his mouth. Can I catch it from him? If so, how can I prevent catching it?
Q. i just got over a cold sore using abreva is this best remedy to use? i didnt get a cold sore for while but i think problems lately have caused them to appear?