Genital herpes, although an ancient disease, was relatively uncommon in the United States until the late 1960's. Spread primarily through sexual contact, the disease has become the most common venereal disease in this country, afflicting an estimated 20 million Americans, with 500,000 new cases occurring each year.
Genital herpes is among the many diseases caused by herpes virus, a family of viruses with five different strains afflicting humans with a variety of diseases that include chicken pox, shingles and mononucleosis. The most common strain, herpes simplex, has two variations: Type 1, which is usually associated with cold sores or fever blisters around the mouth; and Type 2, which generally infects the genitalia, buttocks and thighs with painful sores and blisters. The two types are not confined to these areas, however; studies have found Type 1 herpes virus in genital sores and Type 2 viruses in mouth and throat infections. Other parts of the body also may be affected, including the hands, eyes, brain and spinal cord.
Although herpes viruses cause a wide variety of illnesses and have been studied extensively for the last few decades, they remain a medical enigma. Once they invade the body, herpes viruses remain for life although they may be dormant most of the time. some, such as the varicella-zoster strain, may have different manifestations. This variety causes chicken pox in children, after which the virus remains dormant in the nervous system. In most people, the virus never again becomes active, but for unknown reasons, in others it may erupt into painful attacks of herpes zoster, more commonly known as shingles. Similarly, herpes simplex also goes through recurring cycles of infectious activity and dormancy.
The new "Scourge"
The disease is spread most commonly by direct contact, meaning that to get herpes, uninfected skin must come in contact with an active herpes sore. Oral sex is believed to explain the presence of Type 1 herpes sores in the genital areas or Type 2 infections of the throat and mouth. Recent studies have found that the herpes simplex virus can survive for short periods on toilet seats, towel and other such items, but most experts doubt that the disease is very likely to be contracted from these sources. It is highly contagious through direct contact, but in order to pass herpes to another person, there usually must be an active herpes sore or blister, although there may be a shedding of the virus without suffering symptoms of an attack. Also, since herpes sores may be hidden in the internal parts of the female genitalia or may not be painful, one may unwittingly infect others.
Typically, the herpes virus multiplies rapidly once it has penetrated the skin. The first symptoms are usually an itching or tingling sensation, followed by the eruption of sores or blisters that are unusually painful. In fact, the pain usually exceeds the actual medical seriousness of the disease. In the first attack, the sores customarily appear two days to two weeks after exposure and last two to three weeks. Subsequent attacks, which may occur in a few weeks or not for years, generally last about five days. Fever, general malaise and headaches may accompany the first attack; these symptoms as well as the pain of the sores are usually milder in recurring attacks.
Once an attack subsides, the virus becomes dormant, raveling along the nerve fibers until it reaches a resting place. In rare cases, the herpes virus may travel to the brain causing a serious, often fatal, form of encephalitis. More commonly than it infects the brain, herpes may infect the cornea of the eye; if untreated, a herpetic eye infection can lead to visual damage and even blindness. About 500,000 such eye infections occur each year in the United States. Type 2 virus may invade the spinal cord, causing a type of meningitis. None of these complications, however, is as common as recurrences at the original site of infection.
Other Complications of Genital Herpes
The most serious complications of genital herpes affect infants born to women who have active infections at the time of birth. About 50 to 60 percent of newborns who contract disseminated heres infections die and half of those who survive may suffer brain damage or blindness. Many doctors recommend that the baby be delivered by cesarean if the mother has an active infection near the time of delivery. The decision of whether to have a cesarean should be made early in labor, since cesarean becomes a less effective preventive measure the longer the membranes have been ruptured. Women who have had genital herpes also are advised to have frequent examinations for active infection during the last three months of pregnancy.
There have been reports of an increased incidence of cervical cancer among women with genital herpes, but the evidence is not conclusive.
Treatment of Genital Herpes
As noted earlier, the herpes virus remains in the body, and as yet, there is no cure for genital herpes. However, a new drug, acyclovir, has been developed and recently approved for use in the U.S., that will shorten the length of symptoms with the first attack, which is generally the most severe. It works by interfering with the replications of the virus, thus speeding the healing process in the first episode, but it does not prevent recurrence. Tests are now being conducted on an oral form of the drug. An intravenous form, recently approved for use in the U.S., appears to be the most effective in severe cases.
Other types of treatment include the use of lasers to "vaporize" the herpes sores.
Prevention of Genital Herpes
The surest way of preventing herpes is avoiding all sexual contact with an infected person. Use of a condom and spermicidal agent will reduce the risk, but this is not absolutely foolproof, particularly when the lesions are on the skin of the perineum and not on the penis or in the vagina.
Psychological Factors
Although genital herpes itself is not usually a medically serious disease, it can lead to depression and other emotional problems. Many victims tend to resent the sex partner from whom they contracted the disease, leading to divorce or the breaking up of a relationship. Others consider themselves "unclean" or damaged for life, fearing that they are unfit for marriage or a lasting relationship. A number of herpes counseling centers and groups have been formed throughout the country to lend support and help to victims of the disease.
Summing Up
Genital herpes has become the most widespread sexually transmitted disease in this country. While not as medically serious as syphilis or gonorrhea, it is very uncomfortable and can recur at any time. It also can be life-threatening to infants who are exposed to the herpes virus at the time of birth. A new drug has proven effective in easing the symptoms and speeding the healing in patients with the first episode. Although other treatments are in the experimental stage, no cure exists as yet.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
