Herpes Simplex Type II

Herpes simplex virus (HSV), a recurrent viral infection, is caused by Herpes virus hominis (HVH), a widespread infectious agent.  Attempts at controlling this infectious disease as well as latent infections associated with herpes viruses is an area presently being actively explored. The human herpes viruses, which include Herpes simplex virus types 1 and 2, human cytomegalovirus, Varicella-Zoster virus, and the Epstein-Barr Virus, either cause or are associated with a whole spectrum of diseases ranging from infectious mononucleosis to malignancies and mental retardation.  Indeed, the herpes viruses are multipotential, having the abilitly to cause more than one kind of disease.

Herpes simplex virus type II primarily effects the genital area and is transmitted by sexual contact.  However, cross-infection may result from orogenital sex.  While generally not dangerous, it is a nuisance, can be painful and may be emotionally traumatic.  While there is no cure, the frequency and severity of attacks can be reduced.

Incidence; Causes and Development

Genital herpes is one of the leading sexually-contracted diseases.  Spreading every day, genital herpes is considered an epidemic in the making.  Due to the mode of transmission, genital herpes are rarely seen in children.  However by early teens, when sexual contact begins, genital infections rise dramatically, continuing for the next twenty years.

Genital herpes requires intimate body contact, either through intercourse or oral sex.  As a result of oral sex, Herpes I can be found in the genital area and/or Herpes II can be found on the mouth.  Both HSV-1 and HSV-2 can cause genital herpes.  Roughly speaking, HSV-2 causes 60% and HSV-1 causes 40% of all cases.

General causes of recurrent genital infection include common stressful conditions such as menstruation, emotional upset, pregnancy, and local trauma to the genitalia.  It is common to have an outbreak a week after having intimate sex.

Signs and Symptoms

A first infection with genital herpes generally occurs three to seven days after sexual exposure.  Often people do not notice this infection for the first time, while others have their worst outbreak.  Symptoms vary from a slight fever to a group of blisters which crust over and disappear.

Genital Herpes: symptoms include itching, burning in the genital area and discomfort urinating, and a watery vaginal or urethral discharge.  A weeping vesicular eruption in the vagina or on the penis is an early sign.

Typical symptoms
The virus starts to multiply when it gets into the skin cells.  The skin becomes red and sensitive, and soon afterward, one or more blisters or bumps appear.  The blisters first open, and then heal as new skin tissue forms.  During a first outbreak, the area is usually painful and may itch, burn or tingle.  Flu-like symptoms are also common.  These include swollen glands, headache, muscle ache or fever.  Herpes may also infect the urethra, and urinating may cause a burning sensation.

Generally speaking, visible symptoms (lesions) will show up after standard prodromal symptomology (mild tingling and burning near areas where an outbreak will occur).  Prodromal symptomology does not always precede an outbreak.  The onset of an outbreak is evidenced by watery blisters.  The herpes virus is most infectious during the blistering stage, less infectious after the blisters crust over, yet may be passed on to your partner during the prodromal stage or right after the blisters disappear.

For women, blisters involve the external genitalia (the labia, perirectal skin, foreskin of the clitoris), in addition to the vagina and cervix.  It is common to have watery discharge and pain during urination.

For men, groups of blisters appear on the head, foreskin, or shaft of the penis including surrounding areas of the genitalia.  Generally, herpes can show up anywhere in the pelvic area both front and back. 

It is common among men and women to experience low-grade fever, headache, generalized muscle aching, and tender, swollen lymph nodes in the groin.  The first visible outbreak can last anywhere from 3 to 6 weeks.

Diagnosis and Tests

If you think you have the virus, see a doctor while symptoms are still present.  The doctor will look at the area, take a sample from the sore(s) and test to see if the herpes virus is present.  The test you should request is a specific virus culture or assay for herpes virus.  Remember, the test will not work if the sores have healed.  Known available tests are: Cell Culture Test, Antigen test, Pap Smear.

To determine whether the symptoms you have just experienced are in fact a herpes virus, you can have two separate blood tests for herpes viruses, one for Herpes I and one for Herpes II.  This will determine if herpes is present and which virus is active.

Treatment and Prevention

Although there is no cure, there are measures that can be taken to reduce the effects.  During an outbreak, keep the infected area as clean and dry as possible.  This will help your natural healing processes.  Some doctors recommend warm showers in order to cleanse the infected area.  Afterwards, towel dry gently, or dry the area with a hair dryer on a low or cool setting.  To prevent chaffing, some people also find it helpful to avoid tight-fitting undergarments.  Most creams and lotions do no good and may even irritate.

Finally, a healthy immune system may be important in controlling the virus.  Don't ignore the need for proper nutrition, exercise, and rest.

Prognosis

Recurring Herpes Episodes. Recurring herpes falls into three categories:

1. After the first outbreak or primary outbreak, the virus never shows up again.
2. Herpes outbreaks are so mild, the person is unaware of their occurrence.
3. Periods of chronic, repeated episodes of active ulcerations may continue for months or years.

Those persons in category 2 can move into category 3 or recede into category 1.  For those persons in category 2 and 3, severity and periodicity does calm down after two to three years.

There is reason to believe that the frequency of recurrent herpes is related not only to the health of the patient but to the virus strain itself.  Some strains of virus are more prone to frequent reactivation while others tend to remain quietly latent in the body.  It is also important to point out that almost all spontaneous reactivations come from latent virus in the base of the spinal chord and rarely from exposure during sexual activity.