Genital herpes is
Genital herpes
a contagious viral infection affecting primarily the genitals of men and women. It is characterized by recurrent clusters of vesicles and lesions at the genital areas. It is caused by the Herpes Simplex-2 virus (HSV-2), one of several strains of the Herpes Simplex Virus responsible for chickenpox, shingles, mononucleosis, and oral herpes (fever blisters or cold sores, HSV-1). While generally not dangerous, it is a nuisance and can be emotionally traumatic, as there is no cure.
It has reached epidemic proportions in the U.S.; 500,000 are diagnosed each year.
One in five American adults has herpes, but only one third of those inflicted are aware that they have the virus. Many people don't relate their symptoms to herpes, since they have either very mild or no symptoms at all. Over 50 million cases are currently estimated to exist in either the active or dormant stage.
Theory of Cause:
...Dr. C.N. Look
Herpes simplex viruses include two distinct but closely related viruses, namely, HSV-1 and HSV-2. Both viruses can cause genital herpes. Roughly speaking, HSV-2 causes 90% and HSV-1 causes 10% of all genital herpes. Herpes simplex virus is a linear double-stranded DNA virus. HSV-1 and HSV-2 share approximately 50% homology of their genetic materials and they even express type-common surface antigens. It accounts for the high degree of cross-reactivity and the technical difficulty in differentiating the 2 viruses. On the other hand, HSV-1 & HSV-2 antibodies offer some degree of cross protection. Cell-mediated immune responses is more important than humoral responses in determining the severity of HSV infections. Hence, AIDS patients often have chronic and severe anogenital herpes. Genital herpes is usually transmitted by sexual intercourse. Direct inoculation of virus occurs through contact with infected secretions or mucosal surfaces. Orogenital contact with a partner with type 1 herpes labialis can also result in genital herpes. Asymptomatic shedding of HSV is the most common mode of transmission of genital herpes infection. It is estimated that more than half of the HSV-2 genital infections are asymptomatic.
FACTS ABOUT GENITAL HERPES:
Transmission is caused by close oral, anal, or genital contact, including intercourse, masturbation, kissing, or any direct skin-to-skin contact which allows for the transfer of bodily fluids.
A person is considered contagious when prodromal symptoms, active sores, and healing lesions are present.
Herpes is potentially contagious when no symptoms are present. That is, a person who has genital herpes is potentially always shedding active virus.
Approximately 1 in 6 members of the general infected population is thought to shed active virus occasionally without symptoms.
Some people do not get typical blister-like sores but harbor active virus in their saliva, vaginal, or penile secretions, and can shed the virus without knowing they have herpes.
Lesions can occur deep inside the vagina where they cannot be seen or felt, but can readily transmit the virus.
An uninfected individual has about a 75% chance of contracting herpes during intimate contact with someone actively shedding virus.
Oral herpes can be transmitted to the genitals, and vice versa. Symptoms are similar.
Auto-inoculation: An infected individual can spread the virus to other parts of his or her body by touching an area shedding virus and then touching, scratching, or rubbing another susceptible part of the body. Towels are especially conducive to this.
It is possible for a person to contract genital herpes if the partner with oral herpes performs oral sex. Oral herpes can be transmitted to the genitals, and vice versa. Symptoms are similar.
Environmental surfaces like toilet seats may be a source of contagion, but there is no evidence that this poses a real threat to the general population.
Experts differ as to how long the virus can survive on its own. The primary cause of infection remains intimate contact.
TRANSMITION
How do you get Herpes?
Herpes is spread by direct skin to skin contact. Unlike a flu virus that you can get through the air, herpes spreads by direct contact, that is, directly from the site of infection to the site of contact. For example, if you have a cold sore and kiss someone, you can transfer the virus to their mouth. Similarly, if you have active genital herpes and have vaginal or anal intercourse, you can give your partner genital herpes. Finally, if you have a cold sore and put your mouth on your partners genitals (oral sex), you can give your partner genital herpes.
When Is Herpes Most Likely To Be Spread?
Herpes is most easily spread when a sore is present, but, it is also often spread at other times too. Some people notice itching, tingling or other sensations before they see anything on their skin. These are called "Prodromal Symptoms" and they warn that virus may be present on the skin. Herpes is most likely to be spread from the time these first symptoms are noticed until the area is completely healed and the skin looks normal again. Sexual contact (oral, vaginal, or anal) is very risky during this time.
Can Herpes Be Transmitted Without Symptoms?
Yes! Sometimes those who know they are infected spread the virus between outbreaks, when no signs or symptoms are present. This is called "Asymptomatic Transmission."Research also shows that herpes simplex infections are often spread by people who don't know they are infected. These people may have symptoms so mild they don't notice them at all or else don't recognize them as herpes.
Many genital herpes infections are spread from persons who are asymptomatic "Shedders" of the virus.
For those who recognize their symptoms, asymptomatic transmission appears to be far less likely than spreading the virus when lesions are present.
Many couples have had sexual relations for years without transmitting herpes. Some simply avoid having sexual contact when signs or symptoms are present. Others use condoms or other protection between outbreaks to help protect against asymptomatic shedding.
Are complications possible?
One kind of complication involves spreading the virus from the location of an outbreak to other places on the body by touching the sore(s). The fingers, eyes, and other body areas can accidentally become infected in this way. Preventing self-infection is simple. Do not touch the area during an outbreak. If you do, wash your hands as soon as possible. The herpes virus is easily killed with soap and water.
What about pregnancy?
Can babies get herpes?
Babies can become infected with the herpes virus. If you've been exposed to herpes, you need to talk with your doctor about it before you get pregnant. This is important even if you've never had symptoms or haven't had a recurrence in a long time. The doctor might arrange a test to see if virus is present when you go into labor. In addition, you should be examined to see if you have herpes at labor and should notify the doctor if you think you have active symptoms at that time.
If no virus is found in the birth canal and there are no symptoms or signs of an outbreak, a vaginal delivery is considered safe. If herpes is present in the birth canal near the time of delivery, a cesarean section might be necessary to protect the newborn from coming into direct contact with the virus.
Babies also can get herpes if they are kissed by someone with a cold sore. A young baby cannot fight off infections as easily as an adult can, so serious problems might result. It's important that you do not kiss a baby when you have a cold sore.
Can herpes cause AIDS?
Herpes simplex virus is not related to Human Immuno-Deficiency Virus (HIV), the cause of AIDS. Studies suggest that sores or lesions in the genital area make a person more prone to HIV infection if they have sex with someone carrying HIV. This may be because sores create breaks in the skin of the genitals and make it easier for HIV to get into the body. Given that herpes causes such lesions, it is extremely important to avoid sex during outbreaks. Further research is being conducted in this area.
SYMPTOMS
Herpes Symptom Evaluation
How many outbreaks have you had in the past year ? If it was only one, it was one too many. You spend a great deal of your life, suffering physically and mentally. You wait for the next outbreak wondering if you could have prevented it. Wouldn't it be wonderful if the current outbreak was to be your last?
What happens when you first get herpes?
Symptoms of herpes usually develop within 2 to 20 days after contact with the virus, although it could take longer. These symptoms may last up to several weeks, varying from one person to the next. In many people, the first infection is so mild that it goes unnoticed. In others, the first attack causes visible sores. Even so, subsequent recurrences of the disease may cause lesions. When the sores are completely healed, the active phase of infection is over. Healing of the skin usually leaves no scars. In either case, the virus retreats into the nervous system and lies dormant.
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.
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.
PRECATIOINS
Why condoms and foams?
Laboratory studies have shown that the herpes virus does not pass through latex condoms. When properly used, such condoms are likely to reduce your risk of spreading or getting herpes. Nonlatex polyurethane condoms break up to five times more often, but even the best latex condoms don't guarantee safety. Sometimes herpes sores occur in places not covered by a condom. In these cases, the condom is of little help, if any. In fact, condoms and foams should not be relied upon when herpes sores or symptoms are present.
Some contraceptive foams contain ingredients (such as nonoxynol-9) that kill the herpes virus and other STDs in test tubes. They are best used along with condoms, not in place of condoms.
What else can I do after diagnosis?
Many people feel panicked or depressed when they have herpes. Partly as a result of these feelings, the first few outbreaks can cause a great deal of stress. It may be important, therefore, to take additional steps.
First, get the information you need so you aren't worrying unnecessarily. Understanding herpes gives you a positive way to deal with your concerns. Second, seek emotional support when you need it. Keeping your feelings to yourself may do more harm than good.
What precautions can I take?
Certain basic principles about reducing risk apply equally to herpes and other sexually transmitted diseases (STDs):
You can eliminate your risk of getting herpes by not having sex with anyone (abstinence) or by having sex with a non-infected partner who has sex only with you (mutual monogamy).
If you are not sure that you and your partner are free from infection, use protection during sex. Latex condoms, used properly from start to finish for each sexual encounter, can be useful protection.
Spermicidal foams, creams, and jellies may offer additional protection.
SELF HELP
Does Herpes Recur?
Yes, both oral and genital herpes can recur. Some people have frequent recurrences, while other people have them rarely. The average for genital herpes is about 4 recurrences per year. Most people with genital herpes do have recurrences.
At the beginning of the infection, the herpes virus escapes the immune defenses by entering the nerve endings and travelling to the ganglia, which are clusters of nerve cells. In the ganglia, the virus is inactive and it causes no harm to the body or the nerve cells. From time to time, however, the virus can be reactivated. When that happens, it travels back down the nerve to the surface of the skin. There it starts to multiply, causing another outbreak. Recurrences usually develop near the site of the initial infection.
Symptoms Of A Typical Recurrence:
During a first episode, the immune system develops antibodies and other weapons against the virus. During a recurrence, then, this "immune memory" helps fight off infection more quickly. As a result, there are usually fewer sores, they heal faster, and the outbreak is less painful. The flu like symptoms of the first outbreak are seldom present.
What Triggers A Recurrence?
Herpes infections have different patterns in different people. Any one or combination of the following factors might sometimes, not always, induce an outbreak: surgery, illness, stress, fatigue, skin irritation (such as sunburn), diet, menstruation, or vigorous sexual intercourse.
A recurrence of the herpes infection may occur when latent viruses are triggered by immunosuppressive events such as emotional stress, sunlight, menses, cold or fevers, certain foods, beverages, vitamins and medications.
Since the recurrence pattern of herpes is almost as varied as the people who harbor the virus, you should take every precaution possible to keep the virus in remission.
PREGNANCY
HERPES and PREGNANCY
"I had several outbreaks during pregnancy and was terrified I would pass the infection to my baby," Maria wrote to the Herpes Resource Center. "But I didn't have an outbreak at my delivery, and at my doctor's recommendation I delivered vaginally. I gave birth to a healthy, eight-pound baby girl. I want to tell other mothers that I know it's hard not to worry when your baby's safety is at stake. But please think positive thoughts and trust your doctor. My daughter, now 12 months, is healthy and beautiful. I wish the same for your family. "
Maria's story is echoed by many. While neonatal herpes is rare, women who know they have genital herpes are often concerned about the possibility of transmitting the virus to their babies at birth.
On the one hand, such concern is understandable, because herpes can have devastating consequences for a newborn. But on the other hand, the risk is extremely low, experts agree especially for women with known, long-standing infections.
Neonatal herpes is not a reportable disease in most states, so there are no hard statistics on the number of cases nationwide. However, most researchers estimate between 1,000 and 3,000 cases a year in the United States, out of a total of 4 million births. To put this in greater perspective, an estimated 20-25% of pregnant women have genital herpes, while less than 0.1% of babies contract an infection. "Neonatal herpes is a remarkably rare event", says Zane Brown, MD, an expert on neonatal herpes and a member of the Department of Obstetrics and Gynecology at the University of Washington. "Compared to all the other possible risks in a pregnancy, the risk of neonatal herpes is extremely small."
"I think it's perceived to be more of a problem than it is", says Scott Roberts, MD a researcher in the Department of Maternal Fetal Medicine at the University of Kansas. "The rate of neonatal herpes is very low, even though the prevalence of genital herpes in our country is quite common."
Transmission rates are lowest for women who acquire herpes before pregnancy -- one study (Randolph, JAMA, 1993) placing the risk at about 0.04% for such women who have no signs or symptoms of an outbreak at delivery. The chances of transmission are highest when a woman acquires genital herpes late in pregnancy.
Unfortunately, when infants do contract neonatal herpes, the results can be tragic. About half of infants who are treated with antiviral medication escape permanent damage. But others may suffer serious neurological damage, mental retardation or death. It's fear of these terrible consequences, rather than the level of risk, that makes neonatal herpes a concern.
If you are pregnant and you-have genital herpes, you will want to talk with your obstetrician or midwife about how to manage the infection and minimize the risk to your baby.
If you are a man with either oral or genital herpes and your partner is uninfected and pregnant, you can do even more to protect the baby. Since the highest risk to an infant comes when the mother contracts HSV-1 or 2 during pregnancy, you can take steps to ensure that you don't transmit herpes during this crucial time.
So learn what you need to know, and then relax and enjoy the excitement of the pregnancy -- and remind her that the odds are strongly in favor of you're having a baby as healthy and happy as Maria's.
How Neonatal Herpes Is Spread
In about 90% of cases, neonatal herpes is transmitted when an infant comes into contact with HSV- 1 or 2 in the birth canal during delivery. There is a high risk of transmission if the mother has an active outbreak, because the likelihood of viral shedding during an outbreak is high. There is also a small risk of transmission from asymptomatic shedding (when the virus reactivates without causing any symptoms).
Fortunately, babies of mothers with long-standing herpes infections have a natural protection against the virus. Herpes antibodies in the mother's blood cross the placenta to the fetus. These antibodies help protect the baby from acquiring infection during birth, even if there is some virus in the birth canal. That's the major reason that mothers with recurrent genital herpes rarely transmit herpes to their babies during delivery. Even women who acquire genital herpes during the first two trimesters of pregnancy are usually able to supply sufficient antibody to help protect the fetus.
Babies born prematurely may be at a slightly increased risk, however, even if the mother has a long-standing infection. This is because the transfer of maternal antibodies to the fetus begins at about 28 weeks of pregnancy and continues until birth. "Babies delivered at term should be protected by antibodies -- but premature babies haven't gotten a full load, "explains Brown.
Mothers who acquire genital herpes during the last trimester of pregnancy may also lack the time to make enough antibodies to send across the placenta. In addition, newly infected people - whether pregnant or not - have a higher rate of asymptomatic shedding for roughly a year following a primary episode. This higher rate of asymptomatic shedding, plus the lack of antibodies, create the greater risk for babies whose mothers are infected in the last trimester.
Mothers who acquire genital herpes in the last few weeks of pregnancy are at the highest risk of transmitting the virus to their infants. If the mother's infection is a true primary (she has no previous antibodies to either HSV-1 or HSV-2), and she seroconverts (becomes HSV positive) at the end of pregnancy, the risk of transmission can be as high as 50%, according to research by Brown and others. The risk is also high if she has prior infection with HSV-1 but not HSV-2.
While acquisition of herpes in the last few weeks of pregnancy is rare, it may account for almost half of all cases of neonatal herpes. If a woman has primary herpes at any point in the pregnancy, there is also the possibility of the virus crossing the placenta and infecting the baby in the uterus. About 5% of cases of neonatal herpes are contracted this way.
Finally, about 5%-8% of babies who contract neonatal herpes are infected after birth, often when they are kissed - by an adult who has an active infection of oral herpes (cold sores).
Prevention:
Mothers with recurrent genital herpes
If you are pregnant and know you have genital herpes, that fact alone gives you a significant advantage in protecting your baby. Studies show that most cases of neonatal herpes occur in babies whose mothers don't have any idea they are infected.
This statistic is due, in part, simply to the large number of people who have genital herpes and don't know it. But it's also due to the lack of precautions taken by women and doctors who don't realize that neonatal herpes is a possibility.
When neither the mother nor her provider knows she's infected, neither are alert for lesions at delivery or likely to notice mild or atypical symptoms of an outbreak. On the other hand, when a woman and her provider do know there's a risk, the provider can examine her visually with a strong light at the onset of labor. This is currently the best way to detect herpes lesions. The provider can also take a viral culture at delivery to aid in diagnosis, should the baby become sick later.
"If we know you have herpes, we're going to be watching you closely, asking you about lesions and looking for them, and watching the baby closely afterward," says Lawrence Stanberry, M.D., director of the Division of Infectious Diseases, Children's Hospital Medical Center in Cincinnati.
In addition, findings presented at the 1994 International Herpes Management Forum suggest that women who are educated about genital herpes can often identify lesions even more accurately than their doctors. Women can also identify prodromal symptoms. Women can increase the likelihood of a doctor's spotting mild or atypical outbreaks by pointing to the site where lesions usually occur.
While some women may feel awkward discussing herpes in the delivery room, the best course is to think of the baby's well-being and be frank, doctors say. "It can be hard with three or four people there you've never seen before, but the important thing is to forget the stigma that unfortunately exists and just come out with it," says Roberts.
Lesion at delivery
If a woman does have a lesion or prodromal symptoms at delivery, the safest practice is a cesarean delivery to prevent the baby from coming into contact with active virus. What are the chances that a woman with recurrent herpes will have a lesion at delivery? Many women find that their outbreaks tend to increase as the pregnancy progresses, probably because of the immune suppression that takes place to prevent the mother's body from rejecting the fetus.
Between 10% and 14% of women with genital herpes have an active lesion at delivery. The odds are higher for women who acquire herpes during pregnancy, and lower for women who have had herpes for more than six years.
Fetal scalp monitor: trouble or no?
One practice that may contribute to transmission of neonatal herpes is the use of a fetal scalp monitor (scalp electrodes) during childbirth. This instrument, which is used to monitor the baby's heartbeat, actually makes tiny punctures in the baby's scalp. Several studies have shown that those breaks in the skin may serve as portals of entry for herpes virus.
While the risk from the scalp monitor may be quite small, a cautious approach would be for a pregnant woman to ask that it not be used unless there is a compelling medical reason.
"If a woman has a history of recurrent herpes, her obstetrician should carefully weigh the risks and benefits," says Stanberry. "In most cases the fetal scalp monitor shouldn't be used. There are other ways to monitor the heart rate." An alternative is the external monitor, which tracks the baby's heartbeat through the mother's abdomen.
No lesion at delivery
If a woman doesn't have herpes lesions at the time of delivery, the standard of care recommended by the American College of Obstetrics and Gynecology (ACOG) is vaginal delivery. This does expose the baby to a very small risk of infection from possible asymptomatic shedding. The case for vaginal delivery is built on a number of strong arguments.
First, the percentage of babies who acquire neonatal herpes from mothers who have no active lesions at delivery is exceedingly small. In a study of 15,923 pregnant women in Seattle, only one baby contracted neonatal herpes from a mother with recurrent HSV who was shedding asymptomatically at delivery (Brown, New England Journal of Medicine, 1991). Other studies have found an even lower rate of transmission.
"The risk is not zero, but it's extremely low," says Stanberry. By comparison, studies have found that many more women shed virus at delivery -- approximately 1.4% of women tested by viral culture, and some 20% of women tested by ultra-sensitive PCR (polymerase chain reaction) technology. The dramatic difference between the numbers of babies infected and mothers shedding virus have led researchers to conclude that even babies who are exposed to viral shedding rarely become infected, probably because of maternal antibodies passed through the placenta.
The second argument for vaginal delivery is that there is no practical way to detect viral shedding quickly enough to affect a delivery decision. Prior to 1988, ACOG recommended that doctors culture women for HSV-2 in the last few weeks before delivery, in an effort to identify women who are shedding. However, several studies demonstrated that these culture tests are useless for predicting which women will be shedding at delivery, as shedding tends to last only a few days at most.
While some doctors still continue the practice of weekly cultures to determine the need for a C-section, experts now believe this simply causes unnecessary cesareans - without providing any protection to babies.
For example, a 1995 study at University of Texas Southwestern Medical Center in Dallas showed that since the hospital adopted ACOG's 1988 recommendation of delivering women with genital herpes vaginally, in the absence of visible lesions, the rate of cesarean delivery dropped by 37%, and no babies had contracted neonatal herpes (Roberts et al., Obstetrics &' Gynecology, 1995).
Some mothers do request a C-section because they want to do everything possible to avoid infecting their babies. "Many mothers may be willing to put themselves at risk for their babies," says Laurie Scott, M.D., of the Department of Obstetrics and Gynecology at the University of Texas. "But the reality is that a C-section is a potentially dangerous situation."
Maternal illness following a cesarean is approximately 28%, compared with 1.6% following a vaginal delivery. Cesareans require long recovery times, and in some instances can even be fatal.
"If we were doing C-sections on every mother with genital herpes, we'd end up losing almost as many women as we were saving babies," says Zane Brown.
Furthermore, the protection offered by C-sections is not absolute. In various studies, between 16% and 30% of infants infected with neonatal herpes were born by cesarean (in most of these cases the cesarean was performed after the membranes had ruptured).
At the same time, babies delivered vaginally, even in the presence of active lesions have an infection rate of only 0.25%-5%."Every center that does research has cases where a lesion is identified after delivery," explains Brown. "The obstetrician will notice it while stitching the mother after an episiotomy, for example. In most cases, those babies don't get infected". This again shows the protective power of maternal antibodies.
In short, for mothers with recurrent genital herpes, even the practice of delivering by cesarean in the case of visible lesions is conservative in light of the very few actual cases of neonatal herpes.
"We're not operating on mathematical assumptions," says Scott. "We're operating on real-world observations of how few babies get neonatal herpes."
Prevention: Men with Genital Herpes
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If you are a man and know you have genital herpes, you have a key role in protecting your unborn child from neonatal herpes. As discussed above, the baby is at the greatest risk when the mother acquires an infection during the last trimester of pregnancy.
This happens most often when neither parent realizes that there is a risk of transmission. So, the first step is for both you and your pregnant partner to find out for sure who is infected and who is not.
At the moment, HSV screening for all pregnant women nationwide is not practical. An accurate, type-specific serology (blood test) is not available in most commercial labs. However, one accurate serology -- the Western blot -- is available from the University of Washington at Seattle (206-548-6066). To find out how you or your partner can get a Western blot, ask your doctor to call the lab at the number listed here. Your partner may also wish to have a Western blot late in pregnancy, since two-thirds of women who acquire genital herpes in pregnancy never have symptoms -- meaning neither they nor their doctors know there is a risk for neonatal herpes.
If your partner finds that she is infected, she can talk with her obstetrician or midwife about how to minimize the risk at delivery. If you are infected and she is not, you can take precautions to prevent transmission during pregnancy.
Such precautions include - abstaining from sex when you have active outbreaks, using condoms for intercourse between outbreaks, and possibly abstaining from intercourse during the last trimester. Explore alternatives to intercourse, such as touching, kissing, fantasizing, and massage.
If you have oral HSV-1 (approximately 50%-80% of adults do), avoid oral sex when you have an active outbreak (cold sore). HSV-1 can spread to your partner's genital area and give her genital herpes. Some 20%-30% of neonatal herpes cases are caused by HSV-1, so this is a real danger.
While these precautions may mean changing your sexual practices for a few months, you can have the reassurance of knowing that you have prevented the single most dangerous risk of neonatal herpes to your baby.
Women who get herpes during pregnancy
Many women who have their first outbreak of genital herpes during pregnancy do not actually have a new infection - instead, the outbreak is the first symptomatic recurrence of a longstanding infection. If you experience your first outbreak late in pregnancy, get a Western blot serology, if at all possible. (See above, for how to get a Western blot.) If performed promptly, a Western blot can tell you whether the outbreak is a true primary (a new infection in a person with no previous antibodies to either HSV-1 or HSV-2), a non-primary first episode (an infection of HSV-2 in a person with previous antibodies to (HSV-1), or a recurrence. Ask your doctor to let the lab know how many weeks pregnant you are.
A woman who has a primary episode in the last trimester, especially in the last four to six weeks, may be treated to reduce the viral load. Some experts might also recommend a cesarean delivery under these circumstances. "If a woman becomes infected during the third trimester, even if she's treated, there's a higher risk for shedding at delivery, says Stanberry. "In this situation, a C-section may really be of help, even if she has no symptoms or visible lesions." However, ACOG recommends a vaginal delivery if no lesions are present.
Unfortunately, most women who acquire herpes during the last trimester are unaware of their infection. Thus, neither they nor their babies receive the attention, treatment, and care they would receive if the infection were known.
Experimental approaches
Acyclovir is occasionally prescribed for pregnant women who suffer from extremely frequent outbreaks, or those who acquire genital herpes during pregnancy. The use of acyclovir, valacyclovir, or famciclovir during pregnancy is not recommended by ACOG or approved for use during pregnancy by the Food and Drug Administration. Ongoing studies may clarify the role of antiviral medications.
After the Baby Is Born
The possibility of acquiring neonatal herpes after birth is a risk for every baby. When such infections do occur, the cause is almost always HSV-1, which spreads from an adult who has an oral infection (cold sore). In many cases, the adult is a family member who has no idea that the minor irritation of the cold sore can be dangerous to an infant with an immature immune system.
To help protect your baby, educate family members about the danger of cold sores. Don't kiss your baby when you have an active sore, and also ask friends and relatives not to do so. In addition, if you have an outbreak of genital herpes, be sure to wash your hands before touching the baby. No extreme precautions are necessary. There is no risk in holding the baby, breast feeding, or having the baby in bed with you.
If the baby's mother has genital herpes, it is worth keeping a close eye on the baby for several weeks after birth, just to make sure no infection develops. Symptoms usually start in the first 14 days of life and may develop any time in the first month.
Some symptoms, such as blisters on the body, are indicative of herpes. Others, such as lethargy, poor feeding, irritability, or fever could stem from any of a number of minor problems. The important point is that if anything seems wrong with your baby, take him or her to your pediatrician immediately, instead of waiting to see whether the situation will improve. "If the baby doesn't behave well, if it's feverish, irritable, has blisters - don't delay," says Stanberry.
Make sure you tell your pediatrician specifically if either parent has a history of genital herpes. "OBs don't always talk to pediatricians," notes Stanberry. Don't assume something you've told your obstetrician gets conveyed to your pediatrician.
At the same time unless your baby appears to have a problem, expect the best and concentrate your energy on getting used to the new member of the family. "The vast majority of babies born to mothers with genital herpes are healthy, happy babies."
American Social Health Association, 1996
TREATMENT
What's new in the treatment of Herpes?
Researchers are working on many drugs that may eventually provide faster diagnosis and better treatment of recurrent genital herpes.
Vaccines
Herpes vaccines are currently being investigated and it is felt that an effective vaccine may be available in 3-5 years. Vaccines will only function to prevent the infection in new patients. Those who already have the simplex virus disease will probably not gain any benefit. Some vaccines have been tried to prevent the HSV occurrence, but so far had no noticible effects. These include the smallpox, Polio and Lupidon C vaccine.
GlaxoSmithKline Biologicals announced the launch of their phase III trial, called the “HERPEVAC Trial for Women”, which began in November 2002.
Isoniplex (Isoprinosine) is already available in over 56 countries. Most countries have approved it for use in HSV infections due to its antiviral action, and more significantly, the ability to stimulate the body's immune response. Isoniplex is currently under investigational trials for HSV primary and recurrent cases in the United States.
What About Treatment?
Although there is no cure for herpes, some drugs have been effective in reducing the frequency and duration of outbreaks. It might be a good idea to discuss options with your doctor.
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.
Alternative Solutions
We have also provided links to many alternative treatments for those who wish to suppress herpes naturally:
Red Marine Algae, Aviralex, Vir-L-Lysine, Aeura, and H-Balm
Facts About Facts
The program described, we can confidently say, has changed more lives and helped create more peace of mind than any other programs ever developed for the remission of herpes. It helps people get their lives back on track, and has also saved many friendships.
Two control methods are being examined today. One is an antiviral therapy, and the other is immunotherapy.
The object of antiviral therapy is to develop drugs that can distinguish cells which harbor the virus from those that do not. These drugs must be selective by destroying the virus inside infected cells without harming normal cells. The drug must destroy the entire virus without leaving fragments or producing mutants that may cause later problems. Essentially, antiviral agents must only be lethal to viruses, but also non-toxic to body cells.
Immunotherapy is an exciting area of medicine. Immunological researchers are developing agents that help fight viruses naturally by stimulating the body's immune response system. Some currently available substances can activate the specialized white blood cells.
Diet is a very important factor in keeping herpes in remission. It has been found that foods high in I-Arginine may cause herpes outbreaks.
The Amino Acid Lysine Controls Herpes
Is it true that the amino acid called lysine, is good for herpes outbreaks?
Yes. Supplementation with free-form lysine has shown to be beneficial in controlling herpes along with a diet high in lysine and low in arginine. "This suggests that physicians in a position to study the effect of lysine in herpes simplex infections should do so. It appears to do no harm and may be a useful therapeutic measure."
Tissue culture studies have demonstrated a beneficial effect on viral replication when the amino acid ratio of arginine to lysine favors arginine. The opposite, preponderance of lysine to arginine, suppresses viral replication and inhibits cytopathogenicity of herpes simplex virus."
L-Lysine appears to be an effective agent for reduction of occurrence, severity and healing time for recurrent HSV infection.
What foods are high in lysine and low in arginine?
Fish, chicken, beef, lamb, milk, cheese, beans, brewer's yeast, mung bean sprouts and most fruits and vegetables have more lysine than arginine, except for peas. Gelatin, chocolate, carob, coconut, oats, wholewheat and, white flour, peanuts, soybeans, and wheatgerm have more arginine than lysine.(See Nutrition)
What are Lysine's Method of Action?
Nine proteins have been identified in the enveloped herpes simplex viron. In addition to the capsid proteins, the naked virions contain two additional proteins (VI and VII). Protein VII is an arginine-rich protein of the viral core. It is also known that the proteins synthesised by the herpes simplex virus infected cells contain more arginine but less lysine, methionine, phenylalanine, tryrosine, and isoleucine relative to leucine than the proteins synthesised by unaffected cells.
L-lysine 390 mg. was given orally at the first indication of onset of herpetic oral lesions in eight patients and vulvar lesions in two patients, with uniform rapid resolution of the lesions. This suggests that physicians in a position to study the effect of lysine in herpes simplex infections should do so. It appears to do no harm and may be a useful therapeutic measure.
Dosages:
The amount of lysine required to control herpes varied from case to case but a typical dose to maintain remission was 500 mg daily and active herpes required 1 to 6 g between meals to induce healing."
REFERENCES:
1. Kagan, C. Lysine Therapy for Herpes Simplex, The Lancet, 1:137 26 Jan 1974)
2. Griffith, R.S., A Multicentered Study of Lysine Therapy in Herpes simplex Infection", Dermatologica 156: 257-267 (1978)
3. Griffith, R.S., Success of L-Lysine Therapy in Frequently Recurrent Herpes simplex Infection, Dermatologica 175: 183-190 (1987)
4. Olshevsky, V., Becher, V. Virology, 1970, 40, 948.5. Kaplan, A.S., Shimano, H., Ben-Porat, T. ibid. p.90.
Working on the theory that people with viral diseases, can benefit from a diet high in lysine and low in arginine, James M. Scutero came up with a chart where foods at the top of the list have higher lysine to arginine ratios.
There are other dietary factors that may influence viral replication and a total approach to nutrition should be used. Use this chart as a guide or a reference only, and see what happens. Look at the absolute figures for Lysine and Arginine content. There is no reason to avoid a food if it has a low Lysine/Arginine ratio and only a few mg of Arginine in it.
Herpes Overview
What is Herpes?
Herpes is a common viral infection.
It causes oral herpes (cold sores or fever blisters), and genital herpes (genital sores or sores below the waist).
There are two herpes simplex viruses:
Herpes Simplex Type 1 (HSV-1)
• Herpes Simplex Type 2 (HSV-2)
These viruses look identical under the microscope, and either type can infect the mouth or genitals. Most commonly, however, HSV-1 occurs above the waist, and HSV-2 below.
The body's natural defense system is called the "Immune Responses". Whenever herpes attacks the immune system, the body fights back against this menace. As the battle grows more intense, there are heavy losses by both the herpes virus and the immune system. This causes the body to be less able to defend itself from attacks by other viruses. For those very reasons, a herpes patient should try to keep the herpes virus under control at all times.
There are two widespread attitudes about herpes:
Herpes does not effect any other part of the body.
There is nothing I can do to keep from having an outbreak.
Both attitudes are wrong!
Remember...
You are not alone. Herpes is estimated to affect some 80 million people in America. At least one in five adults in the United States has genital herpes.
Get more information. The better informed you are about herpes, the easier it will be to manage.
Give yourself the best possible chance to limit recurrences by maintaining general good health and keeping stress to a minimum.
Take care of the affected skin area. Keep the area dry and clean during outbreaks to help healing.
Avoid physical contact with the area from the time of the first symptoms (tingling, itching, burning) until all sores are completely healed, not just scabbed-over.
Also be aware of possible shedding or "asymptomatic transmission", even after the sores have healed.
When properly used, latex condoms help reduce your risk of spreading or getting herpes.
Prevent self-infection to other areas of your body. Wash your hands with soap and water if you touch a sore. Better yet, don't touch the sores.
Prospective parents: If either mother or father has genital herpes, or any of the mother's previous sexual partners had genital herpes, tell your doctor about it.
It is possible to get genital herpes from cold sores.
Women with genital herpes: Don't skip your annual Pap smear.
Inform yourself about herpes. For many, diagnosis with herpes can mean a time of confusion, anger, fear and frustration. For many, it seems there is no place to turn for help in dealing with the sensitive aspects of herpes infection. There is help available.
Increase your intake of L-Lysine and decrease the amount of arginine in your diet.
Herpes is spread by direct contact.
Herpes Epidemic Rise
Oral herpes, an infection caused by the herpes simplex virus, is estimated to be present in 50 to 80 percent of the American adult population. 20 percent, over 50 million people, are infected with genital herpes, also caused by the herpes simplex virus, and the majority of these cases may be unaware they even have it. Studies show that more than 500,000 Americans are diagnosed with genital herpes each year, and the largest increase is occurring in young teens.
There is no cure for herpes to date. Supporting your immune system should be your first goal. A weakened immune system is more prone to outbreaks. Efforts to develop a herpes vaccine by biotechnology companies are ongoing. Until an effective herpes vaccine or cure for HSV infection is found, the prevailing approach to treatment continues to be suppressive antiviral therapy. Links, on this page, go to products and services which can help you cope with herpes in your life.
Why condoms and foams?
Laboratory studies have shown that the herpes virus does not pass through latex condoms. When properly used, such condoms are likely to reduce your risk of spreading or getting herpes. Nonlatex polyurethane condoms break up to five times more often, but even the best latex condoms don't guarantee safety. Sometimes herpes sores occur in places not covered by a condom. In these cases, the condom is of little help, if any. In fact, condoms and foams should not be relied upon when herpes sores or symptoms are present.
Some contraceptive foams contain ingredients (such as nonoxynol-9) that kill
