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Genital Herpes

Overview :

Genital herpes (herpes genitalis, herpes progenitalis) is characterized by the formation of fluid-filled blisters on the genital organs of men and women. The word "herpes" comes from the Greek adjective herpestes, meaning creeping, which refers to the serpent-like pattern that the blisters may form. Genital herpes is a sexually transmitted disease which means that it is spread from person-to-person only by sexual contact. Herpes may be spread by vaginal, anal, and oral sexual activity. It is not spread by objects (such as a toilet seat or doorknob), swimming pools, hot tubs, or through the air.

Genital herpes is a disease resulting from an infection by a herpes simplex virus. There are eight different kinds of human herpes viruses. Only two of these, herpes simplex types 1 and 2, can cause genital herpes. It has been commonly believed that herpes simplex virus type 1 infects above the waist (causing cold sores) and herpes simplex virus type 2 infects below the waist (causing genital sores). This is not completely true. Both herpes virus type 1 and type 2 can cause herpes lesions on the lips or genitals, but recurrent cold sores are almost always type 1. The two viruses seem to have evolved to infect better at one site or the other, especially with regard to recurrent disease.

To determine the occurrence of herpes type 2 infection in the United States, the Centers for Disease Control and Prevention (CDC) used information from a survey called the National Health and Nutrition Examination Survey III (1988–1994). This survey of 40,000 noninstitutionalized people found that 21.9% of persons age 12 or older had antibodies to herpes type 2. This means that 45 million Americans have been exposed at some point in their lives to herpes simplex virus type 2. More women (25.6%) than men (17.8%) had antibodies. The racial differences for herpes type 2 antibodies were whites, 17.6%; blacks, 45.9%; and Mexican Americans, 22.3%. Interestingly, only 2.6% of adults reported that they have had genital herpes. Over half (50% to 60%) of the white adults in the United States have antibodies to herpes simplex virus type 1. The occurrence of antibodies to herpes type 1 is higher in blacks.

Viruses are different from bacteria. While bacteria are independent and can reproduce on their own, viruses cannot reproduce without the help of a cell. Viruses enter human cells and force them to make more virus. A human cell infected with herpes virus releases thousands of new viruses before it is killed. The cell death and resulting tissue damage causes the actual sores. The highest risk for spreading the virus is the time period beginning with the appearance of blisters and ending with scab formation.

Herpes virus can also infect a cell and instead of making the cell produce new viruses, it hides inside the cell and waits. Herpes virus hides in cells of the nervous system called "neurons." This is called "latency." A latent virus can wait inside neurons for days, months, or even years. At some future time, the virus "awakens" and causes the cell to produce thousands of new viruses which causes an active infection. Sometimes an active infection occurs without visible sores. Therefore, an infected person can spread herpes virus to other people even in the absence of sores.

This process of latency and active infection is best understood by considering the genital sore cycle. An active infection is obvious because sores are present. The first infection is called the "primary" infection. This active infection is then controlled by the body's immune system and the sores heal. In between active infections, the virus is latent. At some point in the future latent viruses become activated and once again cause sores. These are called "recurrent infections" or "outbreaks." Genital sores caused by herpes type 1 recur much less frequently than sores caused by herpes type 2.

Although it is unknown what triggers latent viruses to activate, several conditions seem to bring on infections. These include illness, tiredness, exposure to sunlight, menstruation, skin damage, food allergy and hot or cold temperatures. Although many people believe that stress can bring on their genital herpes outbreaks, there is no scientific evidence that there is a link between stress and recurrences. However, at least one clinical study has shown a connection between how well people cope with stress and their belief that stress and recurrent infections are linked.

Newborn babies who are infected with herpes virus experience a very severe, and possibly fatal disease. This is called "neonatal herpes infection." In the United States, one in 3,000-5,000 babies born will be infected with herpes virus. Babies can become infected during passage through the birth canal, but can become infected during the pregnancy if the membranes rupture early. Doctors will perform a Cesarean section on women who go into labor with active genital herpes.

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