Genital Herpes Recurrent Infections - PowerPoint Presentation

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Genital Herpes

Recurrent Infections

What is Genital Herpes?Sexually transmitted infection caused by a virusCommon signs and symptoms of initial infectionSmall 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/ulcersPainful urinationAlso 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

Genital HerpesSecond 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 lesionsApprox. 50 million people infected with HSV-2About 1 in 6 Americans age 14 - 49 is infected with HSV-2

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.

Genital Herpes HSV-1 is an increasingly important cause of genital herpes in industrialized countries.In a large study, younger women ages 18 – 22were 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 populationTwo potential reasons for increase in HPV-1 in young people.Decrease in HPV-1 exposure in childhoodIncrease in oral-genital sex in young people

Herpes Ulcers

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

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 result in genital herpes in the partner3Can 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.

Clinical Spectrum of HSV-2

Source: Ashley RL, Wald A. 1999. Clin Microbiol Rev.

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

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Other Effects of HSV-1 and 2HSV 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.

How Often Does it Recur?More than 90% infected with HSV-2 have recurrence during first year1Recurrences are less frequent (20%-40%) for oral herpes (mainly by HSV-1)225%--50% of eye infections with HSV recur within2 years2

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

How is Herpes Treated?There is no cure for herpesAntiviral drugs reduce the duration of lesions and viral shedding but do not eliminate the infection1Genital herpes patients who are experiencing chronic stress should consider also being treated for their stress to help prevent breakouts.2

How Does Herpes Affect Newborns?Neonatal herpes -- Results from transmission from mother to infant and can be either HSV-1 or HSV-2If mother is recently infected, 30%-50% of vaginally delivered infants become infected1If mother has a recurrence of herpes during pregnancy, <8% newborns become infected1

Watts DH, et al. 2003. Am J Obstet Gynecol.

How Does Herpes Affect Newborns? (cont)1 in 3,200 live births are affected with an estimated 1,500 cases per year.150% cases of newborn infection occur to mothers with no known history of genital infection2If untreated, causes death or brain damagein babies3So 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.

Reducing Herpes RiskAn effective vaccine has not yet been developed1There is some evidence of risk reduction with condom use, but only if used 100% of the time.2,3Health workers should wear gloves Awareness of status5

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