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	Genital Herpes
	Definition
	Genital herpes is a recurrent, sexually transmitted viral infection that may be contagious even when its characteristic sores are absent. Because genital herpes is incurable, considerable stigma and emotional trauma have been associated with the disease. While no one relishes the thought of having an incurable, recurring disease, much of the hysteria over herpes is unwarranted. Except in unusual circumstances, the disease is more uncomfortable than serious. New cases of genital herpes develop among hundreds of thousands of people every year, striking all social and economic classes in epidemic proportions.
	Cause
	Genital herpes is caused by the herpes simplex Type 2 virus, a close cousin of the Type 1 virus that causes cold sores. Herpes usually spreads to sexual partners during active manifestation of the disease but herpes carriers can still spread the disease in the absence of lesions and other symptoms. Though most people suffer recurrences, most successive episodes are briefer and milder. Among many people, recurrences eventually cease. Spread by any form of sexual contact, the herpesvirus invades the body through tiny breaks in mucosal linings. About 6 days after infection, the first symptoms lesions surface. After the symptoms go away, the virus travels along the nerves to the deep nerve centers (ganglia) at the base of the spinal cord near the buttocks and enters a silent period of inactivity or latency. When reactivated, it travels back down the nerves, causing a new outbreak in the same area involved in the initial attack and sometimes on the buttocks, thighs, and abdomen as well. Anywhere from 50 to 75 percent of people with herpes will suffer a recurrent infection within 3 months of the initial episode. As time passes, attacks are farther apart and less severe. The precise mechanism causing reactivation of the latent viruses is not known, but chronically ill or stressed people seem to have the most attacks. Other precipitating factors are thought to be menstruation, pregnancy, emotional distress, local trauma to the genitals, and even sexual intercourse.
	Diagnosis
	Mild tingling and burning may precede the actual appearance of herpes skin sores; within a matter of hours, fluid-filled blisters develop, often extensively. In women, the blisters, or vesicles, usually involve the external genitalia (the labia, skin around the rectum, and foreskin of the clitoris) as well as the vagina and cervix, which protrudes into the vaginal canal of the end of the uterus. There is often watery discharge and pain during urination. Among men, the blisters break out on the penis and sometimes on the thighs. Both men and women may experience low-grade fever, headache, generalized muscle ache, and tender, swollen lymph nodes in the groin. In about 2 days, the vesicles become pustular (pus-producing) and coalesce into large, painful ulcerlike sores. These crust over, dry, and heal without treatment (and leave no scars). Although the entire episode, from the appearance of the blisters to the disappearance of all symptoms, lasts about 3 weeks, the herpes can still be contagious for up to 2 weeks after symptoms fade. (The virus is most infectious in the blistering stage but can also be transferred during the tingling period just before the sores appear). Genital herpes can be definitively diagnosed by a microscopic examination of a scraping from a sore and by culturing such a specimen in a aboratory.
	Treatment
	Although no drug cures herpes, acyclovir taken orally relieves discomfort and reduces contagion by shortening the period during which viruses are shed. Local anesthetics such as lidocaine and drying agents may also relieve symptoms.
	Prevention
	Sexual activity should be curtailed at the first sign of an imminent attack and should not be resumed until 1 week after all symptoms have disappeared (2 weeks in the case of the initial infection). The use of a condom is wise but not a guarantee of preventing spread. Oral acyclovir can prevent recurrent attacks but once the drug is stopped herpes may strike again.
	Male/Female Differences
	Women are at greatest risk from complications of genital herpes: Herpes (as well as other viral genital infections) increase the risk of later cervical cancer, and any woman who has suffered the disease should have periodic Pap smears to detect cervical cancer at its earliest stages. Herpes may also be passed to a baby born during an active infection, possibly causing serious difficulties including blindness, neurological problems, mental retardation, and even death. So pregnant women should be watched closely for signs of an active infection near the time of delivery. If there is danger of passing the infection to the baby, a cesarean section is advised.