Sexually Transmitted Diseases 101

Herpes (HSV)

Genital Herpes affects more than 30 million Americans, and a half million new cases are diagnosed every year.

There are two forms of genital herpes -- herpes simplex virus-1 and herpes simplex virus-2. Although herpes-1 is most often associated with cold sores and fever blisters, both forms of herpes may be sexually transmitted.

During pregnancy, herpes may cause miscarriage or stillbirth. If active herpes infections are present during childbirth, newborn infants may suffer serious health damage, including developmental disabilities and (rare) death.

Transmission is more common during the first episode of the herpes infection and less common during a recurrent herpes outbreak. Like many other viruses, the herpes simplex virus (HSV) remains in the body for life.

Symptoms of HSV

Symptoms of HSV include:

• A recurring rash with clusters of itchy or painful blistery sores appearing on the vagina, cervix, penis, mouth, anus, buttocks or elsewhere

• Painful ulcerations that occur when blisters break open

Primary outbreaks may cause:

• Pain and discomfort around the infected area

• Itching

• Burning sensations during urination

• Swollen glands in the groin

• Fever, headache and a general run-down feeling

Symptoms usually appear between two to 20 days after infection, but years may pass before an outbreak occurs. Recurrences may be related to emotional, physical or health stresses. Practicing strict hygiene is important during recurrences. If the sores are touched inadvertently, wash hands immediately. Be particularly careful when handling contact lenses and touching the eyes.

HSV is spread by touching, sexual intimacy (including kissing) and vaginal, anal and oral intercourse.

HSV may be passed from one partner to another or from one part of the body to another, whenever contact is made with an active herpes virus. Oral sex play can pass herpes from the mouth to the genitals or from the genitals to the mouth.

HSV is most contagious from the time the sores are present until they are completely healed and the scabs have fallen off. Recent studies show that some people may be contagious when they have no symptoms. Mucus membranes of the mouth, anus, vagina, penis, and the eyes are especially susceptible to infection.

Because HSV can be confused with syphilis, chancroid, and other STDs, examination of the sores and laboratory culturing of fluid samples taken from the sores are important. Definitive diagnosis may not be possible if the sores are dried or scabbed by the time you see a clinician. If you think you have herpes, it is important to have a diagnosis early in the outbreak.

While no cure for HSV exists, symptoms can be relieved. Valacyclovir and acyclovir can reduce recurrences.

Partners should refrain from sexual intimacy from the time they know the blisters are going to recur until after the scabs have completely fallen off the healed sores. Condoms offer some protection against the virus between outbreaks.

HPV Genital Warts

Human papilloma virus (HPV) infects 40 million women and men and each year about a million Americans are newly infected with genital HPVs.

More than 60 types of HPVs exist, causing a variety of warts and other conditions and can stay in the system for life. A few HPVs cause genital warts, but most genital HPV infections are not visible and have no symptoms. Some of these are associated with cancer of the cervix, vulva or penis.

Symptoms

Symptoms of HPV include warts on the genitals, in the urethra, in the anus and (rarely) in the throat. Genital warts are soft to the touch, may look like miniature cauliflower florets, and often itch. Untreated genital warts can grow to block the openings of the vagina, anus, or throat and become quite uncomfortable.

Warts usually take from two to three weeks after infection to develop. Genital warts grow more rapidly during pregnancy or when other infections are present.

Genital HPVs are spread by vaginal and anal intercourse. In rare cases, genital warts spread to the fetus during childbirth.

HPVs can be diagnosed by microscopic examination of tissue samples and clinical evaluation of warts during a physical or gynecological exam. Special magnifiers (colposcopes) can detect genital HPVs that cannot be seen with the naked eye during pelvic exams.

Pap tests may reveal pre-cancerous conditions caused by genital HPVs. Early treatment prevents cancer of the cervix. Though genital warts may recur, they can be removed by carefully applying, and often reapplying, a prescription medication, Podofilox, to the wart. Clinicians offer other treatments, including:

• Application of podophyllin or acid

• Standard surgery

• Laser surgery (vaporizing the wart with a beam of high-powered light)

• Cryosurgery (freezing the wart with liquid nitrogen)

• Injection of interferon

Condoms may offer some protection against genital HPVs, but the viruses may "shed" beyond the area protected by a condom.