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Sexually transmitted diseases (STDs) are those diseases transmitted primarily through sexual means, which may include oral, anal, or genital contact; osculation (kissing); or manual stimulation. STDs are also referred to as sexually transmitted infection (STI), venereal diseases (VD), and reproductive tract infections (RTI). Though other diseases may also be transmitted through sexual contact, the term STD is reserved for an infection spread primarily through sexual means. The source of infection may be bacterial, fungal, viral, or parasitical. Depending upon the infecting agent, the resulting disease may remain localized at the site of infection (such as the genitalia or sex organs) or may spread to other parts of the body. Though symptoms may vary, both men and women are susceptible to STDs.

The most reliable method for the prevention of all STDs is abstinence or limiting sexual activity to monogamous, long-term relationships with partners who have been tested and are free of infection. Consistent and correct use of latex condoms may help to prevent the transmission of many STDs but may be ineffective in preventing others.

Genital herpes is an infection caused most often by the herpes simplex virus type 2 (HSV-2) but occasionally by the herpes simplex virus type 1 (HSV-1), which more commonly causes cold sores and fever blisters around the mouth and lips. Genital herpes is widespread in the United States, with one out of five people ages twelve and older being infected. From the late 1970s to the early 1990s the incidence of the disease in the United States increased by 30 percent. HSV infections are more common in women than in men, suggesting that male-to-female exposure is more likely to result in herpes than female-to-male exposure.

Generally, genital herpes occurs when a person engages in sex (oral, anal, genital, or manual stimulation) with someone who has an active infection of HSV-2, even in the absence of visible sores (asymptomatic shedding). Genital herpes may also result from oral-genital or genital-genital contact with a person who has an active HSV-1 infection.

Most people who are infected with HSV-2 or HSV-1 have mild symptoms or none at all and often mistake the outward manifestations of herpes for a rash or insect bite. However, when symptoms do occur, they usually appear within two weeks of infection and may be pronounced (although the virus may lie dormant for extended periods of time before manifesting clinical symptoms). The first occurrence (primary episode) may involve the appearance of one or more blisters on or near the genital or rectal areas. Tender or painful sores (ulcers) result when the blisters break. These open sores may take from two to four weeks to heal. More sores, flu-like symptoms, and/or swollen glands may also accompany the primary outbreak. Recurrence is common and most people who show symptoms of a primary infection typically have four to five outbreaks within the year. Though HSV may remain in the body indefinitely, subsequent outbreaks generally occur with less frequency and less severity over time.

The clinical manifestation of genital herpes in immunocompromised individuals can be serious. Pregnant women who have active genital herpes at the time of delivery may transmit the infection to their babies during vaginal delivery, which may result in life-threatening infections in the infants. Women who have clinical symptoms at the time of delivery can undergo a cesarean section to prevent transmission to the baby or may undergo antiviral suppression therapy during the third trimester of pregnancy to preserve the option of vaginal delivery.

Though the mechanism is not fully understood, people who have genital herpes are more susceptible to contracting HIV infections if exposed to it. People who have genital herpes are also more likely to transmit HIV to uninfected partners.

Though there is no cure for herpes, antiviral medications may shorten and lessen the severity of subsequent outbreaks. Daily suppressive therapy may reduce the transmission of symptomatic genital herpes to uninfected partners.

Because HSV shedding may occur outside the areas normally covered by a condom, even consistent and correct usage of latex condoms offers only limited protection from the transmission of herpes. People with active infections should abstain from sexual activity with others.

Reference:

Holmes, King K.; P. Frederick Sparling; Per-Anders Mardh; et al., eds. 1999. Sexually Transmitted Diseases. 3rd edition. New York: McGraw-Hill.

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