Genital herpes

Synonyms Anogenital herpesviral infection, herpes genitalis
Genital herpes in a female
Classification and external resources
Specialty Infectious disease
ICD-10 A60
ICD-9-CM 054.1
MedlinePlus 000857
MeSH D006558

Genital herpes is a genital infection caused by the herpes simplex virus (HSV). Most individuals carrying herpes are unaware they have been infected and many will never suffer an outbreak, which involves blisters similar to cold sores.[1][2] While there is no cure for herpes, over time symptoms are increasingly mild and outbreaks are decreasingly frequent.[3][4] When symptomatic, the typical manifestation of a primary infection is clusters of genital sores consisting of inflamed papules and vesicles on the outer surface of the genitals, resembling cold sores.[5] These usually appear 4–7 days after sexual exposure to HSV for the first time.[6] Genital HSV-1 infection recurs at rate of about one sixth of that of genital HSV-2.[7]

HSV has been classified into two distinct categories, HSV-1 and HSV-2.[4][8] Although genital herpes was previously caused primarily by HSV-2, genital HSV-1 infections are increasing and now cause up to 80% of infections.[9]

In 2013 about 1.1 billion people (15.9%) had asymptomatic genital herpes and 47 million new cases of genital herpes occurred.[10] A 1998 study indicated it was the most common sexually transmitted infection by the number of cases.[11]

Signs and symptoms

Genital herpes in a male

In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus.[5]

Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise.[6] Women often experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal intercourse.[6]

After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts.[6] In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash.[12][13] Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined.[12]

Recurrence

After approximately 80% of first episodes of herpes genitalis caused by HSV-2, there will be at least one recurrence, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%.[14] Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year.[14]

People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir.[15] Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor.[15] People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy.[16] Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency.[16]

Treatment

As of November 2015, genital herpes cannot be cured. Moreover, genital herpes can be transmitted by viral shedding prior to and following the visual signs of symptoms. There are, however, some drugs that can shorten outbreaks. Among these drugs are acyclovir, valacyclovir, and famciclovir.

Acyclovir is an antiviral drug used against herpes viruses, varicella zoster viruses, and Epstein–Barr viruses. This drug reduces the pain and the number of lesions in the initial case of genital herpes. Furthermore, it decreases the frequency and severity of recurrent infections. It comes in capsules, tablets, suspension, injection, powder for injection, and ointment. The ointment is used topically and it decreases pain, reduces healing time, and limits the spread of the infection.[17]

Valacyclovir is also used to treat herpes virus infections. Once in the body, it is converted to acyclovir. It helps relieve the pain and discomfort and the sores heal faster. It only comes in caplets and its advantage is that it has a longer duration of action than acyclovir.[18] An example usage is 1000 mg by oral administration twice per day for 10 days for primary lesion, and 500 mg orally twice per day for 3 days for a recurrent episode.[19]

Famciclovir is another antiviral drug that belongs to the same class as acyclovir and valacyclovir. Famciclovir is a prodrug that is converted to penciclovir in the body. The latter is the one active against the viruses. This drug has a longer duration of action than acyclovir and it only comes in tablets.[20]

Epidemiology

About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases.[21] More than 80% of those infected are unaware of their infection.[22] Annually, 776,000 people in the United States get new herpes infections.[22]

Tests for herpes are not routinely included among STD screenings. Performers in the pornography industry are screened for HIV, chlamydia, and gonorrhea with an optional panel of tests for hepatitis B, hepatitis C and syphilis, but not herpes. Testing for herpes is controversial since the results are not always accurate or helpful.[23] Most sex workers and performers will contract herpes at some point in their careers whether they use protection or not.[24]

History

Early 20th century public health legislation in the United Kingdom required compulsory treatment for sexually transmitted diseases but did not include herpes because it was not serious enough.[25] As late as 1975, nursing textbooks did not include herpes as it was considered no worse than a common cold. After the development of acyclovir in the 1970s, the drug company Burroughs Wellcome launched an extensive marketing campaign that publicized the illness, including creating victim's support groups.[25]

Research

There are efforts to develop a vaccine, but the results so far has not been able to cure herpes or eliminate transmission.[26]

Vaccine Company Lead Researcher Vaccine Type Status
HSV-2 ICP0‾ HSV-2 0ΔNLS[27] Rational Vaccines RVX William Halford[28] Live, Attenuated Looking for Volunteers
dl5-29 / ACAM-529 / HSV-529 Sanofi Pastuer David Knipe[29] ? Phase I
Admedus[30] Admedus Ian Frazier Sub Unit Phase II
HerpV Agenus ? ? ?
Gen-003 Genocea ? Sub Unit Phase II
Vical Vical ? ? Phase II
Einstein Einstein Med College William Jacobs Jr ? Preclinical
GV2207 GenVec ? ? ?
Mymetics[31] Mymetics ? ? ?
AIC316 AICuris ? ? ?
Vitaherpavac & Herpovax ? ? ? ?
NE-HSV2[32] NanoBio[33] ? ? Preclinical
Profectus BioSciences ? ? ? ?
Biomedical Research Models ? ? ? ?
Tomegavax ? ? ? ?
Herpevac ? ? ? Discontinued
PaxVax ? ? ? ?
Amgen BioVex ? ? ? ?
AuRX ? ? Live, Attenuated Inactive
Zostavax (VZV, shingles) Merck ? Live, Attenuated In Production
Varicella (C.Pox) Merck ? Live, Attenuated In Production

References

  1. ↑ "Genital Herpes - CDC Fact Sheet". Retrieved 2013-11-09.
  2. ↑ Malkin JE. (2004). "Epidemiology of genital herpes simplex virus infection in developed countries.". Herpes. 1: 2A–23A.
  3. ↑ David M. Koelle, MD; Jacqueline Benedetti; Andria Langenberg, MD; Lawrence Corey, MD (1992). "Asymptomatic Reactivation of Herpes Simplex Virus in Women after the First Episode of Genital Herpes". Annals of Internal Medicine. 116 (6): 433–437. doi:10.7326/0003-4819-116-6-433.
  4. 1 2 Nahmias Aj; Dowdle W.R. (1968). "Antigenic and biologic differences in herpesvirus hominis.". Prog Med Virol. 10: 110–59. PMID 4304588.
  5. 1 2 "STD Facts - Genital Herpes". Retrieved 2008-02-22.
  6. 1 2 3 4 Gupta R, Warren T, Wald A (2007). "Genital herpes". Lancet. 370 (9605): 2127–37. doi:10.1016/S0140-6736(07)61908-4. PMID 18156035.
  7. ↑ Lafferty We; Coombs RW; Benedetti J; Critchlow C; Corey L (1987-06-04). "Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type". N Engl J Med. 316 (23): 1444–9. doi:10.1056/NEJM198706043162304. PMID 3033506.
  8. ↑ Dowdle Wr; Nahmias AJ; Harwell RW; Pauls FP. (1967). "Association of antigenic type of Herpesvirus hominis with site of viral recovery". J Immunol. 99 (5): 974–80. PMID 4295116.
  9. ↑ Beigi, Richard H. (ed.). Sexually transmitted diseases. Chichester, West Sussex: John Wiley & Sons, Ltd. p. 139. ISBN 9781118314975.
  10. ↑ Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England). 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMID 26063472.
  11. ↑ Antonio C Gerbase; Jane T Rowley; Thierry E Merten (1998). "Global epidemiology of sexually transmitted diseases". Lancet. 352: S2–S4. doi:10.1016/S0140-6736(98)90001-0.
  12. 1 2 Sakakibara R, Yamanishi T, Uchiyama T, Hattori T (August 2006). "Acute urinary retention due to benign inflammatory nervous diseases". Journal of neurology. 253 (8): 1103–10. doi:10.1007/s00415-006-0189-9. PMID 16680560.
  13. ↑ Vonk P (December 1993). "Elsberg syndrome: acute urinary retention following a viral infection". Nederlands tijdschrift voor geneeskunde (in Dutch and Flemish). 137 (50): 2603–5. PMID 8277988.
  14. 1 2 How the facts about Genital Herpes can help. By New Zealand Herpes Foundation. Retrieved June 2014
  15. 1 2 Le Cleach, L; Trinquart, L; Do, G; Maruani, A; Lebrun-Vignes, B; Ravaud, P; Chosidow, O (Aug 3, 2014). "Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients.". The Cochrane database of systematic reviews. 8: CD009036. doi:10.1002/14651858.CD009036.pub2. PMID 25086573.
  16. 1 2 2007 National Guideline for the Management of Genital Herpes. By Clinical Effectiveness Group at British Association for Sexual Health and HIV.
  17. ↑ "Medications and Drugs". Retrieved 2010-05-03.
  18. ↑ "Brand Name: Valtrex". Retrieved 2010-05-03.
  19. ↑ Canadian Guidelines on Sexually Transmitted Infections > Section 5 - Management and Treatment of Specific Infections > Genital Herpes simplex virus (HSV) Infections. from the Public Health Agency of Canada. Date Modified: 2013-02-01.
  20. ↑ "Brand Name: Famvir". Retrieved 2010-05-03.
  21. ↑ Allen, JoAnne (2010-03-09). "U.S. herpes rates remain high - CDC". Reuters. Retrieved 2013-05-03.
  22. 1 2 "Genital Herpes - CDC Fact Sheet". Retrieved 2013-06-03.
  23. ↑ "Prevent STDs like a porn star". CNN. 2011-05-19. Retrieved 2013-11-04.
  24. ↑ "Sore Subject: The Symptoms of Herpes Aren't Just Physical". Retrieved 2013-11-04.
  25. 1 2 "The courts should keep out of our sex lives". Retrieved 2013-06-13.
  26. ↑ Hofstetter, AM; Rosenthal, SL; Stanberry, LR (Feb 2014). "Current thinking on genital herpes.". Current opinion in infectious diseases. 27 (1): 75–83. doi:10.1097/qco.0000000000000029. PMID 24335720.
  27. ↑ "Introducing RVx". 2016-03-12. Retrieved 2016-08-02.
  28. ↑ "Herpes Vaccine Research". Herpes Vaccine Research. Retrieved 2016-08-02.
  29. ↑ "Knipe Lab | Harvard Medical School". knipelab.med.harvard.edu. Retrieved 2016-08-02.
  30. ↑ "Admedus US Research & Development - Admedus US". www.admedus.com. Retrieved 2016-08-02.
  31. ↑ "Herpes Simplex". MyMetics. Retrieved 2016-08-03.
  32. ↑ "Nanobio - HSV-2 Vaccine". Retrieved 3 August 2016.
  33. ↑ Corporation, NanoBio. "NanoBio's Genital Herpes Vaccine Demonstrates Efficacy In Guinea Pigs As Both A Prophylactic And A Therapeutic Vaccine". Retrieved 3 August 2016.
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