SEXUALLY TRANSMITTED DISEASES
Sexually Transmitted Diseases Treatment Guidelines --- 2002 from CDC

CRABS
HERPES
HERPES FACTS
herpes vaccine
Broccoli May Thwart Herpes Virus
CHLAMYDIA
GONORRHEA
GENITAL WARTS
MOLLUSCUM CATAGIOSUM
VAGINITIS
SYPHILIS
PID
September 2003
 Genital Herpes
What is genital herpes?
Genital herpes is an infection caused by the herpes simplex virus or HSV. There are two types of HSV, and both can cause genital herpes. HSV type 1 most commonly infects the lips, causing sores known as fever blisters or cold sores, but it also can infect the genital area and produce sores. HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth. A person who has genital herpes infection can easily pass or transmit the virus to an uninfected person during sex.
Both HSV 1 and 2 can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin.
HSV remains in certain nerve cells of the body for life, and can produce symptoms off and on in some infected people.
According to the U.S. Centers for Disease Control and Prevention, 45 million people in the United States ages 12 and older, or 1 out of 5 of the total adolescent and adult population, are infected with HSV-2.
Nationwide, since the late 1970s, the number of people with genital herpes infection has increased 30 percent. The largest increase is occurring in young teens. HSV-2 infection is more common in three of the youngest age groups which include people aged 12 to 39 years.
How does someone get genital herpes?
Most people get genital herpes by having sex with someone who is having a herpes “outbreak.” This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. Sometimes, however, a person can have an outbreak and have no visible sores at all. People often get genital herpes by having sexual contact with others who don’t know they are infected or who are having outbreaks of herpes without any sores.
A person with genital herpes also can infect a sexual partner during oral sex. The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.
What are the symptoms?
Unfortunately, most people who have genital herpes don’t know it because they never have any symptoms, or they do not recognize any symptoms they might have. When there are symptoms, they can be different in each person. Most often, when a person becomes infected with herpes for the first time, the symptoms will appear within 2 to 10 days. These first episodes of symptoms usually last 2 to 3 weeks.
Early symptoms of a genital herpes outbreak include
Itching or burning feeling in the genital or anal area
Pain in the legs, buttocks, or genital area
Discharge of fluid from the vagina
Feeling of pressure in the abdomen
Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar.
Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.
Can outbreaks recur?
If you have been infected by HSV 1 and/or 2, you will probably have symptoms or outbreaks from time to time. After the virus has finished being active, it then travels to the nerves at the end of the spine where it stays for a while. Even after the lesions are gone, the virus stays inside the nerve cells in a still and hidden state, which means that it’s inactive.
In most people, the virus can become active several times a year. This is called a recurrence. But scientists do not yet know why this happens. When it becomes active again, it travels along the nerves to the skin, where it makes more viruses near the site of the very first infection. That is where new sores usually will appear.
Sometimes, the virus can become active but not cause any sores that can be seen. At these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. You may not notice this shedding because it often does not cause any pain or feel uncomfortable. Even though you might not be aware of the shedding, you still can infect a sex partner during this time.
After the first outbreak, any future outbreaks are usually mild and last only about a week. An infected person may know that an outbreak is about to happen by a tingling feeling or itching in the genital area, or pain in the buttocks or down the leg. For some people, these early symptoms can be the most painful and annoying part of an episode. Sometimes, only the tingling and itching are present and no visible sores develop. At other times, blisters appear that may be very small and barely noticeable, or they may break into open sores that crust over and then disappear.
The frequency and severity of recurrent episodes vary greatly. While some people have only one or two outbreaks in a lifetime, others may have several outbreaks a year. The number and pattern of repeat outbreaks often change over time for a person. Scientists do not know what causes the virus to become active again. Although some people with herpes report that their outbreaks are brought on by another illness, stress, or having a menstrual period, outbreaks often are not predictable. In some cases, outbreaks may be connected to exposure to sunlight.
How is genital herpes diagnosed?
Because the genital herpes sores may not be visible to the naked eye, a doctor or other health care worker may have to do several laboratory tests to try to prove that symptoms are caused by the herpes virus. A person may still have genital herpes, however, even if the laboratory tests do not show the virus in the body.
A blood test cannot show whether a person can infect another with the herpes virus. A blood test, however, can show if a person has been infected at any time with HSV. There are also newer blood tests that can tell whether a person has been infected with HSV 1 and/or 2.
How is genital herpes treated?
Although there is no cure for genital herpes, your health care worker might prescribe one of three medicines to treat it as well as to help prevent future episodes.
Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)
Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. (See section below: How can I protect myself or my sexual partner?)
During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people.
Keep the infected area clean and dry to prevent other infections from developing.
Try to avoid touching the sores.
Wash your hands after contact with the sores.
Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was.
Can genital herpes cause any other problems?
Usually, genital herpes infections do not cause major problems in healthy adults. In some people whose immune systems do not work properly, genital herpes episodes can last a long time and be unusually severe. (The body’s immune system fights off foreign invaders such as viruses.)
If a woman has her first episode of genital herpes while she is pregnant, she can pass the virus to her unborn child and may deliver a premature baby. Half of the babies infected with herpes either die or suffer from damage to their nerves. A baby born with herpes can develop serious problems that may affect the brain, the skin, or the eyes. If babies born with herpes are treated immediately with acyclovir, their chances of being healthy are increased.
If a pregnant woman has an outbreak, which is not the first episode, her baby’s risk of being infected during delivery is very low. In either case, if you are pregnant and infected with genital herpes, you should stay in close touch with your doctor before, during, and after your baby is born.
If a woman is having an outbreak during labor and delivery and there are herpes lesions in or near the birth canal, the doctor will do a cesarean section to protect the baby. Most women with genital herpes, however, do not have signs of active infection with the virus during this time, and can have a normal delivery.
Is genital herpes worse in a person with HIV infection or AIDS?
Genital herpes, like other genital diseases that produce lesions, increases a person’s risk of getting HIV, the virus that causes AIDS. Also, prior to better treatments for AIDS, persons infected with HIV had severe herpes outbreaks, which may have helped them pass both genital herpes and HIV infection to others.
How can I protect myself or my sexual partner?
If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus. When used with these precautions, Valtrex can also help prevent infecting your partner during heterosexual sex.
Is any research going on?
The National Institute of Allergy and Infectious Diseases (NIAID) supports research on genital herpes and on herpes simplex virus (HSV-1 and HSV-2). Studies are currently underway to develop better treatments for the millions of people who suffer from genital herpes.
While some scientists are carrying out clinical trials to determine the best way to use existing drugs, others are studying the biology of herpes simplex virus. NIAID scientists have identified certain genes and enzymes that the virus needs to survive. They are hopeful that drugs aimed at disrupting these viral targets might lead to the design of more effective treatments.
Meanwhile, other researchers are devising methods to control the virus' spread. Two important means of preventing HSV infection are vaccines and topical microbicides. Several different vaccines are in various stages of development. These include vaccines made from proteins on the HSV cell surface, peptides or chains of amino acids, and the DNA of the virus itself.
NIAID and GlaxoSmithKline Biologicals are supporting a large clinical trial in women of an experimental vaccine that may help prevent transmission of genital herpes. The trial is being conducted at more than 20 sites in 15 states nationwide. For more information, click here Herpevac Trial for Women.
Topical microbicides, preparations containing microbe-killing compounds, are also in various stages of development and testing. These include gels, creams, or lotions that a woman could insert into the vagina prior to intercourse to prevent infection.
Where can I get help if I’m upset about having genital herpes or I have an infected partner?
Genital herpes outbreaks can be distressing, inconvenient, and sometimes painful. Concern about transmitting the disease to others and disruption of sexual relations during outbreaks can affect personal relationships. If you or your partner has genital herpes, you can learn to cope with and treat the disease effectively by getting proper counseling and medicine, and by using ways to prevent getting infected or infecting someone else, as mentioned above.
Where can I get more information?
National Herpes Resource Center and Hotline
American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709-9940
919-361-8488 (9 a.m. to 7 p.m. Eastern Time, Monday through Friday)
http://www.ashastd.org/hrc/index.html
National STD and AIDS Hotline
1-800-227-8922 or 1-800-342-2437 (24 hours a day, 7 days a week)
National Institute of Allergy and Infectious Diseases
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov
National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://medlineplus.gov
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.cdc.gov
The American College of Obstetricians and Gynecologists
409 12th Street, S.W.
P.O. Box 96920
Washington, DC 20090-6920
202-863-2518
http://www.acog.org

NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.
News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
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Last Updated November 21, 2003 (alt)


 Broccoli May Thwart Herpes Virus
New Research Suggests Compounds in Cruciferous Veggies May Knock Out Herpes
By Denise Mann
WebMD Medical News
Reviewed By Brunilda Nazario, MD
on Monday, April 12, 2004
Sept. 15, 2003 (Chicago) -- A compound found in broccoli, cabbage, and brussels sprouts may hold the key to thwarting the herpes virus, according to preliminary research presented Sunday at the 43rd annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICACC) in Chicago. The new findings may be one more reason to make broccoli one of your five to nine servings of fruit and vegetables each day.
Preliminary lab studies of monkey and human cells found that indole-3-carbinol (I3C), a compound found naturally in broccoli and other cruciferous vegetables such as cabbage and brussels spouts, may interfere with factors that helps cells reproduce.
The researchers found that I3C can inhibit herpes simplex virus, which also requires these factors to reproduce.
Nearly 100% Effectiveness
In their study, the researchers first treated human and monkey cells with I3C. They then infected the cells with one of two strains of the herpes virus, either HSV-1, which can cause either oral or genital herpes, or HSV-2, which causes genital herpes. The researchers also infected the cells with a herpes virus strain known to be resistant to the current available drug therapy, Zovirax.
The compound blocked the virus from reproducing by at least 99.9%, according to lead researcher Terri Stoner, a graduate student at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio.
"[I3C] appeared to inhibit various types of the herpes virus," Stoner tells WebMD. And because it is found naturally in food, the compound appears to be safe.
According to the American Social Health Association, about 50% to 80% of adults in the U.S. have oral herpes and about one in five has genital herpes, but as many as 90% are unaware that they have the virus. As with all viruses, there is no cure.
Herpes is different from other common viral infections because once it is introduced it lives in the body over a lifetime, often without symptoms or with periodic symptoms.
Cautious Optimism
Many experts here exercise caution when interpreting the new findings. "This is very early information, and in contrast to some of the other viruses, we do have some pretty good antiviral therapies for herpes," says Ronald B. Turner, MD, professor of pediatrics at the University of Virginia School of Medicine in Charlottesville.
"It is fairly common for drugs in the laboratory to have some activity, but it is a difficult step to see how the drug works in humans," he says.
"The science is really nice, but it's a huge step to see if the data has any clinical applications," says Per Ljungman, MD, PhD, of the Huddunge University Hospital in Stockholm, Sweden.
He tells WebMD that while we do see resistance to Zovirax in patients with herpes, it occurs predominantly in patients with weakened immune systems due to HIV infection or transplants.
Moreover, he says, "There have been several promising drugs for herpes over the last decade that have never been developed" and that "resistance to [Zovirax] has not been too huge of a problem."
Eat More Broccoli
So should we eat more broccoli if we have herpes?
Both Turner and Ljungman note that there are already many good reasons to eat more broccoli, and while herpes treatment may one day prove to be another good reason, it is way to early to say.
In fact, boiled broccoli has more vitamin C than an orange and as much calcium as a glass of milk, according to the USDA's nutrient database. One medium spear has three times more fiber than a slice of wheat bran bread. Broccoli is also one of the richest sources of vitamin A that is found in the produce section.
Broccoli has also been shown to protect against cancer. Researchers at Johns Hopkins University School of Medicine in Baltimore have discovered that broccoli is rich in substances called isothiocyanates -- chemicals shown to stimulate the body's production of its own cancer-fighting substances.
Scientists at the Harvard School of Public Health in Boston have reported that broccoli, along with spinach, helped to minimize risk for cataracts and prevent stroke.



 Giant Vaccine Effort Starts Against Silent Herpes
Fri Nov 22, 5:27 PM ET  Add Health - Reuters to My Yahoo!

By Maggie Fox

WASHINGTON (Reuters) - The US government is looking for a rare population of women for a new vaccine trial--women who have never been infected with genital herpes or its cousin, the cold sore virus.


The National Institute of Allergy and Infectious Diseases (news - web sites) said on Friday it is working with drug giant GlaxoSmithKline to find 7,500 women to test the vaccine.


The viruses are incredibly common but the hope is a new vaccine will win approval based on the trial's results. If approved, it would be the first vaccine to prevent a sexually transmitted disease.


"More than 1 million new cases of genital herpes are diagnosed in the United States each year," NIAID head Dr. Anthony Fauci said in a statement. "The physical and psychological toll taken by this sexually transmitted disease is considerable."


The trial was started just a day after researchers confirmed the vaccine can prevent up to 70% of genital herpes infections in some women. To the puzzlement of doctors, it does not seem to work in men.


Researchers also announced success this week with another vaccine against a sexually transmitted disease--this one against the human virus blamed for most cases of cervical cancer. The trial of Merck and Co.'s. human papilloma virus (HPV) vaccine showed it protected 100% of women who got it from the HPV-16 virus--one of several types of HPV that cause cervical cancer.


Merck is working on the vaccine with the help of another one of the National Institutes of Health (news - web sites)--the National Cancer Institute (news - web sites).


HPV-16 is another very common virus, infecting up to 20% of US adults. Like herpes, it is often symptomless and thus easily transmitted.


Cervical cancer kills more than 4,000 women a year in the United States and 250,000 worldwide.


ADOLESCENT VACCINE


NIAID vaccine expert Pamela McInnes hopes the trials will eventually usher in an era when teenagers can be vaccinated before they are exposed to some of the most common sexually transmitted diseases.

"I think the company is focusing on an adolescent vaccine as their goal," McInnes said in a telephone interview. "I think this opens the door for the prevention of other STDs."

Between 50% and 80% of Americans are infected with HSV-1, which usually causes cold sores. Up to 20% of those over 12 are infected with HSV-2, the cause of genital herpes.

Genital herpes can not only cause painful and debilitating outbreaks of blisters, but it can kill newborns if passed on by the mother in childbirth.

GlaxoSmithKline's vaccine only works in women who are not infected with either HSV-1 or HSV-2, so it will not be easy to find volunteers for the trial, McInnes said. "We estimate that we will probably need to screen 3 women for every one eligible," she said.

She hopes the vaccine will also prevent HSV-1, thus saving many women from the inconvenience and discomfort of cold sores.

Each of the 7,500 women in the trial will be watched for 20 months. Half the women will be vaccinated with the herpes shot and half against hepatitis A, another virus, so that every woman who volunteers will be protected against a disease.

More information on the trial can be found on the Internet at http://www.niaid.nih.gov/dmid/stds/herpevac/.