A physician should examine new outbreaks of genital or oral ulcers. Sexually active individuals with an outbreak of oral or genital sores and no known history of herpes should see a doctor. Other serious diseases that must be treated at once (such as syphilis) must also be considered. HIV testing is also recommended if a new sore is present. Known herpes carriers who develop an atypical sore (e.g., one that is painless) must be examined to determine if another sexually transmitted disease such as syphilis or gonorrhea has been contracted.
See a doctor at once if you suspect that your newborn may have herpes. A pediatrician should evaluate blistering sores, symptoms of eye infection, or generalized illness with lethargy or neurological signs in a newborn at once, even if the mother has no known history of herpes.
Consult a doctor right away for severe herpes outbreaks, especially if other symptoms are present. In rare cases, herpes may develop into a serious illness involving the liver, lungs, or central nervous system. In this case, you must start antiviral therapy immediately. Even if only skin sores are present, using medication may be warranted to reduce pain and shorten the duration of blisters. Those with frequent or severe recurrences should keep medication on hand to use at the first sign of an outbreak, or should consider taking daily medications to suppress outbreaks.
Simple measures can sometimes prevent outbreaks and relieve symptoms. Applying sunscreen around the mouth before going outdoors may prevent oral outbreaks. Warm baths may help relieve painful genital lesions.
Your doctor is the best source of information on the drug treatment choices available to you.
Special precautions are needed for pregnant women with genital herpes. Pregnant women with a history of genital herpes should be carefully examined for sores at the time of labor. If lesions are visible, the baby should be delivered by cesarean section. After birth, the baby should be watched carefully for signs of infection and treated if symptoms appear. Some experts recommend that if lesions are present on the mother at the time of birth, cultures should be taken from the baby’s mucous membranes to determine if HSV was acquired.
Pregnant women who acquire an initial infection of genital herpes from mid- to late-pregnancy are at special risk, both to their babies, and in rare cases, to themselves. Neonatal herpes, which is often fatal or can leave a baby with permanent brain damage, is a great risk in such cases. In rare cases, pregnant women themselves develop serious, generalized herpes from a primary infection.
HIV testing is recommended for those diagnosed with genital herpes. As risk factors involving sexual activity (having unprotected sex, or having sex with multiple partners) are the same for HIV and herpes, your doctor will likely screen you for HIV if you are diagnosed with genital herpes.
Having any open sore increases the risk of acquiring HIV from others. In addition, the herpes lesions of someone infected with HSV and HIV may contain both viruses, making transmission of both diseases more likely.
Herpes is a lifelong infection, but usually causes only occasional, limited outbreaks. For most people, herpes is more of a nuisance than a serious problem. Although sores are painful, outbreaks become less severe and less frequent over time. For those with more troublesome disease, antiviral medications can usually moderate or suppress outbreaks.
Pregnant women, immunocompromised individuals, and newborns may have more serious disease. People with HIV, certain cancers, or those undergoing organ transplants may have more frequent, more prolonged, or more severe recurrent outbreaks of herpes. Their lesions may also appear to be atypical. Such patients can be more susceptible to generalized disease involving the liver, lungs, central nervous system, or other organs.
Newborns and pregnant women who acquire herpes for the first time are also at higher risk for severe and generalized disease. Antiviral therapy has been effective in moderating recurrent outbreaks and reducing the death rate for the most severe cases. Neurological complications of HSV encephalitis often cause permanent damage.
If you are diagnosed with genital herpes, talk with your doctor about HIV testing, safer sex practices, and how to manage herpes during pregnancy. If you are diagnosed with genital herpes, your doctor will likely test you for other sexually transmitted diseases, including HIV. In addition, herpes infection makes transmission of HIV more likely, providing additional justification for testing.
Herpes is a lifelong disease that can be transmitted to others, even in the absence of lesions. Therefore, you should abstain from sexual activity while lesions are present (when the disease is most infectious), and use condoms at all other times.
If you are pregnant and have herpes, seek counseling regarding ways to protect your newborn from infection. You should report signs of infection during pregnancy, and your doctor should check carefully for lesions during labor.
See your doctor if herpes is more than a simple, bothersome problem to you. Discuss with your doctor the possibility of treating herpes with antiviral medications. You may wish to have them on hand to moderate an outbreak, or you may choose to take them on a daily basis to suppress outbreaks. Medication is generally effective for as long as it is taken. If your medication does not work well for you, your physician may recommend a larger dose or a different antiviral drug.
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