Herpes simplex virus (or HSV) is not as “simple” as it seems
There are two main strains, or types, of this virus: HSV-1 and HSV-2. In the past, it was believed that HSV-1 mainly caused cold sores around the mouth while HSV-2 was responsible for the genital ulcers. More recent studies of the virus have found that HSV-1 is becoming a much more frequent cause of genital ulcers, although HSV-2 is still the most common strain found in genital infections.
The overall percent of the population infected with either HSV-1 or 2 in Canada is unknown, but is estimated at around 50% for HSV-1 and 17% for HSV-2. The rate of infection rises as people get older. HSV-1 causing ‘cold sores’ on the lips is usually acquired in childhood, while HSV-2 exposure resulting in genital disease occurs later, with the onset of sexual activity. Both HSV-1 and HSV-2 can be passed from lips to genitalia or vice versa through direct contact during oral sex.
There are three categories of infections: primary, non-primary first episode, and recurrent.
Primary: infection in a person without antibodies to HSV-1 or 2.
Non-primary first episode: a new infection with HSV-2 in a person with antibodies to HSV-1, or a new infection with HSV-1 in a person with antibodies to HSV-2.
Recurrent: reactivation of HSV where the type of HSV found in the lesion is the same type as antibodies in the serum (ie: HSV-2 in the lesion and HSV-2 antibodies in the blood).
Many people may be infected with the HSV virus and not know it, as only 40% of initial infections have symptoms. Typical symptoms of genital herpes include: multiple, painful genital ulcers approximately 2-3 mm wide; pain with passing urine; and other cold-like symptoms (mild fever, runny nose, sore throat). Atypical or unusual presentations include genital pain without ulcers or viral meningitis. The diagnosis can be confirmed with a swab from the lesion. A blood test can be done to measure antibody levels to HSV-1 and 2 to see if a person has been previously exposed to the virus. Once a person is infected, the virus lives in nerve roots and remains in the body for life.
HSV can be passed from someone without symptoms to other people. This is called asymptomatic shedding, and is very common with HSV. Women are more likely to be infected from a male partner with HSV than the other way around. The initial symptoms typically start four days after exposure, and last up to three weeks. Recurrent episodes are usually shorter and less severe, and can happen months to years apart. Recurrences can be triggered by menses, other infections (like a cold), emotional or physical stress, and even medications. People can often tell when a recurrence is about to happen as they have symptoms like itching or burning at the site of the infection. These are called prodromal symptoms.
Treatment includes antiviral medication such as acyclovir. Symptoms are shorter and less severe with the use of antiviral drugs. For people with frequent recurrences or pregnant women, antiviral drugs can be used to suppress outbreaks as well. This is important as HSV can be passed to a woman’s unborn child, causing infection in the baby.
Although treatment helps with symptoms, prevention is also important. Condom use decreases transmission of the HSV virus by 50%, but is limited because not all lesions may be covered by the condom. The use of a dental dam during male on female oral sex may also afford some protection. [link to the site on sexualityandu where this is described] Infected people taking suppressive medication may be less likely to pass along the virus to their partner. All sexual contact should be avoided when there are prodromal symptoms, or visible or healing lesions.
More details of treatment and HSV in general are available on the Health Canada website.
http://www.phac-aspc
.gc.ca/std-mts/sti_2006/pdf/genital_herpes_virus_e.pdf
Predictors of Gynecologic Care for Urban Teenaged Girls
A recent study looked at the factors involved with gynecologic care for inner-city adolescent girls in New York City. The researchers asked 819 high-school-aged girls to take a computer-based survey on their use of healthcare, sexual activity, and gynecologic exams.
Sixty percent of the girls had an opportunity for a confidential visit with their doctor at their last visit. Only 27% of sexually active girls had told a healthcare provider they were sexually active, and less than half of them had ever had a pelvic exam. The mean age of sexual debut was 15, and the mean number of partners was 2.5 since initiation of sexual activity. The mean interval from initiation of sexual activity to the first pelvic exam was 13 months (range 0-70 months). In the previous year, 19% of those surveyed had a pregnancy, a sexually transmitted infection (STI), or both.
The researchers found four factors predictive of time to first pelvic exam: becoming pregnant or getting an STI, disclosure of sexual activity to a healthcare provider, access to confidential healthcare, and high self-efficacy for accessing confidential healthcare.
For healthcare providers, this emphasizes the need for adolescents to have private time during their visits. Healthcare providers also need to be more diligent in asking about sexual activity and use of contraception in all adolescent groups. Teens need to be aware that their visits to a healthcare provider are confidential and that they are entitled to confidential healthcare. This knowledge may improve their rates of disclosure of sexual activity prior to a undesireable outcome such as pregnancy or STI.
McKee et al. Journal of Adolescent Health.
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