Genital Herpes Information

Herpes in Greek is herpe in meaning "to creep". The Latin name is appropriate describing the way herpetic lesions "creep" and erupt in blisters in a serpent-like pattern. The term herpes pertains to several distinct disorders, herpes simplex, herpes zoster, Epstein-Barr virus and cytomegalovirus.

Herpes Simplex

When individuals refer to herpes simplex they are primarily concerned with two prevalent types, HSV-1and HSV-2. There is a common belief that HSV-1 attacks above the waist and is responsible for cold sores, while HSV-2 attacks below the waist and is responsible for the genital lesions. However, both herpes viruses HSV-1 and II can cause herpetic lesions on the oral mucosa and the genital region. Herpes HSV-1is primarily the cause of recurrent cold sores while HSV-2 are generally responsible for the genital lesions. This brings up the common question can herpes HSV-1 be passed to a partner during oral sex? Yes, HSV-1 herpes can be passed during oral sex.

Please note: For important genital herpes treatment information please scroll down the page.

Herpes HSV-1

HSV-1 infections are tiny, clear, fluid-filled blisters that most often occur on the face or above the waist. Less frequently, HSV-1 infections occur in the genital area. Type 1 may also develop in wounds on the skin.

There are two types of infections termed primary and recurrent. Primary is the first outbreak if blisters, whereas, recurrent represent the secondary outbreaks that occur at various intervals after the primary lesions appear. Although most people when exposed to the virus get infected, only 10% will actually develop lesions when this infection occurs. The lesions of a primary infection appear two to twenty days after contact with an infected person and can last from seven to ten days.

The number of blisters varies from one to a group of blisters. Prior to the blisters appearing there may be a prodromal period were the skin may be very sensitive or actually itch. Once the blisters appear they can be very sensitive and painful and eventually break permitting the fluid inside the blisters to ooze and crust.

The lesions from the primary infection general heal completely without leaving a scar. However, the herpes virus that caused the initial infection remains dormant in the nerves cells of the body. The virus can remain dormant for years or recurrent infections can occur at various intervals. Recurrent infections may occur in the same location or a nearby site. The recurrent infections tend to be milder than the primary infections and are often related to stress, fevers, sun exposure, menstrual periods etc.

The following pictures represent common lesions associated with HSV - 1

This picture depicts a common lesion caused by (HSV-1) These herpetic ulcers are known as cold sores or fever blisters:

This picture depicts a common lesion when the HSV-1 infects a region near the eye:

This picture depicts a common lesion when the HSV-1 infects a region near the nose:

This picture depicts a common lesion when the HSV-1 infects a region on the external surface of the face:

Herpes HSV-2

Herpes HSV-2 virus is primarily responsible for the herpetic lesions in the genital area. These lesions are characterized by the formation of painful fluid-filled blisters on the genital organs of both men and women. Genital herpes is spread via sexual contact from person to person via oral, vaginal and anal sexual activity. Contrary to popular myths one does not contract the herpes virus from toilet seats, swimming pools, door knobs, etc.

HSV-2 herpes viruses has recurrent infections very similar to the recurrent infections described for the HSV-1 virus. Recurrent infections may occur in the same location or a nearby site. The recurrent infections tend to be milder than the primary infections and are often related to stress, fevers, sun exposure, menstrual period, etc.

The prevalence of herpes HSV-2 infection in Europe alone has been estimated by the Centers for Disease Control and Prevention that some 21.1% of the population of individuals ages 12 years and older had antibodies to herpes HSV-2. This means that some 45 million Americans have been exposed at some point to the herpes simplex HSV-2 virus.

Unfortunately, newborn infants who are infected with the HSV-2 virus secondary to an early rupture of the membranes or while passing through the birth canal may experience a severe and even fatal disease. The "neonatal herpes infection" effects some 3,000 - 5,000 infants born in Europe alone.

The herpes simplex virus may also infect the eye and lead to a condition called herpes keratitis. This presents as pain and light sensitivity often with a discharge, and/or a gritty sensation in the eye. Scarring of the eye may result without the proper treatment. Any patient with a suspected eye infection secondary for the herpes virus should be seen immediately by an ophthalmologist.

HSV-1 and HSV-2 can be found and transmitted from the herpetic lesions. However, the herpetic lesion does not have to be present for an individual to become infected with the virus. The virus is contagious when their are no apparent lesions present. An individual almost always acquires an HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. HSV-1 causes most infections of the mouth and lips, however, an individual can acquire HSV-1 in the genital area secondary to oral-genital sexual contact.

HSV-2 may produces only mild symptoms or an individual may be asymptomatic. However, HSV-2 can also cause extremely painful recurrent genital lesions. The HSV-2 infection can also cause complications in individuals who are immune compromised.

The HSV-2 virus can also cause fatal infections in infants if the mother is shedding virus at the time of delivery. Woman who have active genital lesions at the time of delivery, will have to undergo a cesarean section in order to prevent their newborn from being infected with the virus.

Most individual infected with genital herpes are asymptomatic, they are not aware that they have acquired the virus. However, after a dormancy period the initial presentation of the virus can be very painful. The first episode will usually occur within two weeks after the initial contact with the virus.

Women can experience a very severe and painful primary infection. Herpes blisters first appear on the labia majora (outer lips), labia minora (inner lips), and entrance to the vagina. Blisters often appear on the clitoris, at the urinary opening, around the anal opening, and on the buttocks and thighs. In addition, women may get herpes blisters on the lips, breasts, fingers, and eyes. The vagina and cervix are almost always involved which causes a watery discharge. Other symptoms that occur in women are: painful or difficult urination (83%), swelling of the urinary tube (85%), meningitis (36%), and throat infection (13%). Most women develop painful, swollen lymph nodes (lymphadenopathy) in the groin and pelvis. Approximately one in ten women get a vaginal yeast infection as a complication of the primary herpes infection.

Men usually experience the herpes blisters on the penis but can also appear on the scrotum, thighs, and buttocks. Fewer than half of the men with primary herpes experience the constitutional symptoms. Some 30% to 40% of men have a discharge from the urinary tube. Some men develop painful swollen lymph nodes (lymphadenopathy) in the groin and pelvis. Although less frequently than women, men too may experience painful or difficult urination (44%), swelling of the urinary tube (27%), meningitis (13%), and throat infection (7%).

The following genital herpes pictures depict HSV-2 lesions:

Herpes HSV-2 virus is primarily responsible for the herpetic lesions in the genital area. These lesions are characterized by the formation of painful fluid-filled blisters on the genital organs of both men and women. Genital herpes is spread via sexual contact from person to person via oral, vaginal and anal sexual activity.

Warning: the follow pictures graphic and should only be viewed by adults (presentation is necessary to show the nature and severity of these lesions).

This picture depicts a common lesion when the HSV-2 infects a region on the penis:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

For Information Concerning a Free Genital Herpes Online Consultation
(click here for details).

This picture depicts a common lesion when the HSV-2 infects a region on the penis:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

This picture depicts a common lesion when the HSV-2 infects a region on the penis:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

This picture depicts a common lesion when the HSV-2 infects a region on vulva of the female genitalia:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

This picture depicts a common lesion when the HSV-2 infects a region on vulva of the female genitalia:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

This picture depicts a common lesion when the HSV-2 infects a region on vulva of the female genitalia:

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

Recurrent HSV  Outbreaks

Recurrent herpetic outbreaks vary amongst different individuals. However, most individuals have between four to six outbreaks per year. Recurrent infection are generally less severe than the initial outbreak.

Fortunately there are two medications that doctors commonly prescribe that can reduce both the frequency and the severity of the outbreaks, Valtrex (click here for details) and Acyclovir (click here for details).

Following an outbreak the virus then travels to the nerve cells where the virus remains dormant. Currently, it is unknown why the virus becomes active again. However, the recurrent infections tend to be milder than the primary infections and are often related to stress, fevers, sun exposure, menstrual periods etc.

Individuals should know that the virus may be active without the presence of the typical lesions. During these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the penis, vagina, mouth or from lesions that not that noticeable.

Antiviral medications such as Acyclovir and Valtrex can significantly reduce the number of outbreaks and the duration and severity of symptoms once an outbreak occurs. Shedding of the virus during these periods may not be noticeable if there is no pain or increased sensitivity in the region. However, you may be at increased risk to spread the virus to your partner at this time.

Fortunately, there are medications that doctors recommend that will significantly reduce both the frequency of outbreaks and the severity of the ulcers associated with the genital herpes, Acyclovir Genital Herpes Treatment (click here for details) and Valtrex Genital Herpes Treatment (click here for details).

Some 80% of all case of genital herpes remain undetected. Studies show that a high percentage of individuals that become infected from an undiagnosed partner. Therefore, proper diagnosis is essential in controlling the spread of the virus.

The virus often goes undiagnosed secondary to a wide range of symptoms associated with the infection or there is an absence of any visible lesions or symptoms. Many individuals are often embarrassed and distressed and do not seek medical help.

Diagnosing the Herpes Virus

An accurate diagnosis can help individuals who are infected take control of their health and benefit from treatments that may reduce their symptoms and their frequency of infection. Proper diagnosis also decrease the risk of spreading the virus to other individuals. Physicians should take the responsibility to properly educate individuals who are diagnosed with the disease about how to protect their partners. The following represent the different methods in which the HSV-1 and HSV-2 can be diagnosed:

Genital herpes can be accurately diagnosed by your physician based on your medical/sexual history and visual exam of the classic fluid filled herpetic lesions. Unfortunately, this method may not be reliable to make an accurate diagnosis. The active or latent genital herpes in many infected patients are asymptomatic or the patient's symptoms may have already resolved by the time he/she visits the physician.

The following represent the most accurate methods in which to diagnose the herpes virus.

Virus Culture Detection Tests for Herpes

In order to prepare a viral culture a physician must collect cells at the base of the genital lesion using a sterile cotton swab The sample is then tested in the laboratory. An individual must have a active or live infection at the time of the swab test to produce a positive result. If the herpetic lesions or ulcers have begun to heal the test may give a false-negative report. However, when active lesions are present, this method is seen as the gold standard for diagnosing genital herpes.

Serology Blood Tests for Herpes

When an individual becomes infected with the herpes virus the body will produce antibodies designed to fight the virus. These antibodies are specific to each virus and remain permanently in the bloodstream. A blood test for a herpes simplex virus can indicate if someone has been infected at some time during their life.

However this form of testing cannot indicate when or where on the body the initial infection took place, i.e. around the genital or facial region. When an individual who does not have HSV-2 first acquires the virus, their body starts to produce antibodies. They undergo a process called seroconversion which means they go from having no detectable antibodies seronegative to having detectable antibodies seropositive. The length of time from first infection to when antibodies are detectable varies from person to person, and with the ability of the test to detect antibodies in early infection. Therefore, it is possible for a person in the early stages of infection to give a negative result on a blood test despite having herpes.

Therefore, if an individual believes that he/she has been infected with the virus and the test is negative this individual should repeat the test in three to four months. The older blood tests could not reliably tell the difference between HSV-1 and HSV-2 antibodies, however, there are new commercially available tests that have recently been developed bringing new options for diagnosing HSV:

The HerpeSelect™ type-specific HSV antibody detection tests produced by Focus Technologies can effectively distinguish between HSV-1 and HSV-2. These kits after collection must be sent back to a central laboratory for results.

The POCkit® HSV-2 Rapid Test is a single unit, membrane-based immunoassay for the qualitative determination, either in heparinized capillary whole blood taken by finger stick or in serum, of circulating IgG antibodies specific for herpes simplex virus type 2 (HSV-2), which arise as a result of infection with HSV-2. It is intended for in-vitro diagnostic use by health professionals in Point of Care testing (the lab work does not need to be sent to a central laboratory). The presence of antibodies to HSV-2 may be indicative of a previous infection with HSV-2 and may be of value in determination of previous immunological experience and to aid in the diagnosis of HSV associated disease. This assay will not differentiate whether infection is currently in a latent or active state nor does the test diagnose HSV-1.

Genital Herpes Treatment Information

Currently, there are oral medications that can significantly decrease both frequency and the severity of herpes outbreaks. If you have the herpes virus be sure to read the following:

Oral Medication for the Treatment of Genital Herpes

Oral medications including Valtrex and Acyclovir are effective in treating both the primary infection and recurrent outbreaks. When taken orally, these medications significantly reduce the healing time, virus shedding period, and duration of vesicles.

Patients with frequent outbreaks (greater than six to eight per year) may benefit from long term use of oral medications which is called "suppressive therapy." Patients on suppressive therapy have longer periods between herpes outbreaks. The specific dosage used for suppression needs to be determined for each patient and should be reevaluated every few years. Alternatively, patients may use short term suppressive therapy to lessen the chance of developing an active infection during special occasions such as weddings or holidays.

If you have the herpes Virus, fortunately there are two medications that doctors commonly prescribe that can reduce both the frequency and the severity of the outbreaks, Valtrex (click here for details) and Acyclovir (click here for details).

Alternative treatments have also been shown in clinical trials to help reduce the frequency and the severity of outbreaks. An imbalance in the amino acids lysine and arginine is thought to be one contributing factor in herpes virus outbreaks. Researchers believe that by increasing the ratio of lysine to arginine through taking supplemental lysine or eating foods rich in the amino acid: lamb, cheese, egumes, fish, turkey, beef, and chicken. Patients may take 500 mg of lysine daily and increase to 1,000 mg three times a day during an outbreak. I

In order to increase the ratio of lysine to arginine individuals should also make an effort to decrease their intake of the amino acid arginine Foods rich in arginine that should be avoided are chocolate, peanuts, almonds, and other nuts and seeds.

Some herbs additional herbs that have received noteworthy attention for increasing the immune system helping to reduce the number of infections. The following herbs highlight this list:

• Echinacea (Echinacea spp.)
   
• Garlic (Allium sativum)
   
• Marine Algae (dumontiaceae)
   
• Topical ointments may be beneficial if they contain: glycyrrhizinic acid, components of licorice glycyrrhiza glabra, vitamin E, tea oil, Melaleuca spp, baking soda compresses.

Clinical studies also show that there is a positive correlation between levels of stress and the severity and number of outbreaks. Stress management and relaxation exercises i.e. yoga, tai chi, meditation, and hypnotherapy.

There are several other things that a patient may do to lessen the pain of genital lesions including the following:

• Wear loose fitting clothing and cotton underwear.
   
• Using a blow dryer on the "cool" setting to dry the infected area.
   
• Placing an ice pack on the affected area for 10 minutes, followed by 5 minutes off and then repeating this procedure.
   
• Removing clothing or wearing loose pajamas while at home.
• Soaking in a tub of warm water.
   
• Topical ointments may be beneficial if they contain: glycyrrhizinic acid, components of licorice glycyrrhiza glabra, vitamin E, tea oil, Melaleuca spp, baking soda compresses.

Protection From the Herpes Virus

Since genital herpes is a sexually transmitted disease individuals can protect themselves by abstaining from sexual contact. The consistent and proper use of latex condoms can also provide some protection against infection. Condoms do not provide 100% protection, unfortunately, the condom may not adequately cover the entire region where the herpetic lesions reside allowing viral shedding. If a partner has genital herpes there should be an abstinence from sex until the lesions are no longer present.

Individuals should also adhere to the following to prevent the spread of the virus:

• Practice abstinence
   
• Limit the number of sexual partners you have in your lifetime
   
• Make sure that you and your sexual partner use condoms every time you have sex
   
• Wash your hands with soap and water following contact with the sores (already infected with the virus)
   
• Keep the infected area clean and dry to prevent other infections from developing (already infected with
  the virus)
• Avoid scratching and/or touching the sores (already infected with the virus)
   
• Refrain from sexual contact from the first sign of a recurrent episode until the lesions are completely healed (already infected with the virus).

For Information Concerning a Free Genital Herpes Online Consultation
(click here for details).

Sexually Transmitted Diseases that Resemble the Herpes Virus

There are other sexually transmitted diseases that an produce lesions similar to genital herpes including the following:

Chancroid - an acute, contagious infection of the genital skin or mucous membranes caused by Haemophilus ducreyi and characterized by painful ulcers and suppuration of the inguinal lymph nodes. After an incubation period of three to seven days, small, painful papules appear and rapidly break down into shallow, nonindurated, painful ulcers with ragged, undermined edges and a red border. Ulcers vary in size and often coalesce. Deeper erosion occasionally leads to marked tissue destruction. The inguinal lymph nodes become tender, enlarged, and matted together by periadenitis, forming a fluctuant abscess (bubo) in the groin. The skin over the abscess may become red and shiny and may break down to form a sinus

Lymphogranuloma venereum - a sexually transmitted chlamydial disease characterized by a transitory primary lesion followed by suppurative lymphadenitis and lymphangitis and serious local complications. After an incubation period of three to twelve days, a small, transient, non-indurated vesicular lesion forms, ulcerates rapidly, heals quickly, and may pass unnoticed. The first symptom usually is unilateral, tender enlargement of the inguinal lymph nodes, progressing to form a large, tender, fluctuant mass that adheres to the deep tissues and inflames the overlying skin. Multiple sinuses may develop and discharge purulent or bloodstained material.

Granuloma inguinale - a sexually transmitted, progressive infection of the genital skin caused by intracellular bacterium, Calymmatobacterium granulomatis. The initial lesion is a painless, beefy-red nodule that slowly enlarges as an elevated, velvety, malodorous, granulating ulcerated plaque. Sites of infection are the penis, scrotum, groin, and thighs in men; the vulva, vagina, and perineum in women; the anus and buttocks in homosexual men; and the face in both sexes.

Erythema multiform - an inflammatory eruption characterized by symmetric erythematous, edematous, or bullous lesions of the skin or mucous membranes. Onset is usually sudden, with erythematous macules, papules, wheals, vesicles, and sometimes bullae appearing mainly on the distal portion of the extremities (palms, soles) and on the face; hemorrhagic lesions of the lips and oral mucosa can also occur.

Behçet's syndrome - a multisystem, inflammatory, relapsing, chronic disorder that may include mucocutaneous, ocular, genital, articular, vascular, CNS, and GI involvement. Almost all patients have recurrent painful oral ulcers resembling those of aphthous stomatitis; in most patients, these ulcers are the first manifestations of the disease. Similar ulcers occur on the penis and scrotum, where they are painful, or on the vulva and vagina, where they may be asymptomatic.

Inflammatory bowel disease - is related to Crohn's disease and ulcerative colitis which are both characterized by chronic inflammation at various sites in the GI tract. Both cause diarrhea, which may be profuse and bloody.

Contact dermatitis - acute or chronic inflammation, often asymmetric or oddly shaped, produced by substances contacting the skin and causing toxic (irritant) or allergic reactions. Contact dermatitis ranges from transient redness to severe swelling with bullae pruritus and vesiculation are common. Any skin surface exposed to an irritant or sensitizing substance (including airborne ones) may be involved. Typically, the dermatitis is limited to the site of contact but may later spread.

Candidiasis - invasive infections caused by Candida sp, most often C. albicans, manifested by fungemia, endocarditis, meningitis, and/or focal lesions in liver, spleen, kidneys, bone, skin, and subcutaneous or other tissues. Esophagitis is most often manifested by dysphagia. Symptoms of respiratory tract infections are nonspecific, such as cough. Vaginal infections cause itching, burning, and discharge.

Syphilis - is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.

Primary Stage - the time between infection with syphilis and the start of the first symptom can range from 10-90 days. The primary stage of syphilis is usually marked by the appearance of a single sore, chancre, but there may be multiple sores. The chancre is usually firm, round, small, and painless. The lesion appears at the spot where syphilis entered the body. The chancre lasts three to six weeks, and it usually heals on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage - the second stage starts when one or more areas of the skin break into a rash. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.

Late Syphilis - the latent (hidden) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death.

Additional Herpes Virus Information

Herpes Zoster

Herpes zoster, is also referred to as shingles is a viral infection caused by the same virus that causes chicken pox. Individuals that have had chickenpox can later develop shingles. The virus remains dormant or inactive in certain nerve root cells of the body and then secondary to a weaken immune system the virus can erupt. Diseases that weaken the immune system include leukemia, lymphoma, HIV, chemotherapy, steroid treatment, etc. Some 20 percent of those individuals who have had chicken pox will get zoster at some point during their lives. Fortunately, most individuals only have one episode of shingles.

Common lesions associated with Herpes Zoster:

This picture depicts a common lesion when the Herpes Zoster infects a region on the chest of a male patient:

This picture depicts a common lesion when the Herpes Zoster infects a region on left side of a male patient:

This picture depicts a common lesion when the Herpes Zoster infects a region on the back of a female patient:

This picture depicts a common lesion when the Herpes Zoster infects a female breast:

Shingles present as a burning tingling pain or as an area general on one side of the body that is extremely sensitive. The symptoms may be present from 1-3 days prior to the presentation of a rash. The rash soon develops into a group of blisters that look very similar to chickenpox. These lesions can last from one to two weeks. The blisters resolve, however, then pus or dark blood begins to collect in the area prior to them crusting over to form a scab.

Epstein-Barr Virus

Epstein-Barr virus, frequently referred to as EBV, is a member of the herpes virus family and represents one of the most common viruses that infect humans. In Europe, it is estimated that as many as 95% of adults between 35 and 40 years of age have been infected with the virus.

Infants become susceptible to EBV as soon as maternal antibody protection that is present at birth declines.. Many children become infected with EBV, and these infections usually cause no symptoms or are indistinguishable from the other mild, brief illnesses of childhood. In Europe and in other developed countries, many persons are not infected with EBV in their childhood years. When infection with EBV occurs during adolescence or young adulthood, it causes infectious mononucleosis 35% to 50% of the time.

Symptoms of infectious mononucleosis are swollen lymph glands, sore throat and fever. Occasionally , individuals may experience a swollen spleen, involvement of the liver, heart and/or the central nervous system. Mononucleosis is usually self limiting and is rarely ever fatal.

Although the symptoms of infectious mononucleosis usually resolve in 1 or 2 months, EBV remains dormant or latent in a few cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and is commonly found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness.

EBV also establishes a lifelong dormant infection in some cells of the body's immune system. A late event in a very few carriers of this virus is the emergence of Burkitt's lymphoma and nasopharyngeal carcinoma, two rare cancers that are not normally found in Europe. EBV appears to play an important role in these malignancies, but is probably not the sole cause of disease.

Most individuals exposed to people with infectious mononucleosis have previously been infected with EBV and are not at risk for infectious mononucleosis. In addition, transmission of EBV requires intimate contact with the saliva (hence the kissing disease) of an infected person. Transmission of this virus through the air or blood does not normally occur. The incubation period, or the time from infection to appearance of symptoms, ranges from 4 to 6 weeks. Individuals with infectious mononucleosis may be able to spread the infection to others for a period of weeks.

The clinical diagnosis of infectious mononucleosis is suggested on the basis of the symptoms of fever, sore throat, swollen lymph glands, and the age of the patient. Usually, laboratory tests are needed for confirmation. Serologic results for persons with infectious mononucleosis include an elevated white blood cell count, an increased percentage of certain atypical white blood cells, and a positive reaction to a "mono spot" test.

There is no specific treatment for infectious mononucleosis, other than treating the symptoms. No antiviral drugs or vaccines are available. Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published.

Cytomegalovirus

Cytomegalovirus (CMV), infects an estimated 50% - 85% of adults by the age of 40 in Europe. For most healthy individuals who are infected with CMV after birth the virus is self limiting with a mild mononucleosis-like syndrome with prolonged fever, and a mild hepatitis.

Once an individual becomes infected, the virus remains in the body, however, the virus is usually dormant. Recurrent symptoms only present when there is some form of immune compromise secondary to suppressive therapy, cancer, HIV, etc.

CMV infection is important to certain high-risk groups including the following:

• Fetus during pregnancy
   
• Risk of infection to individuals who work with children
   
• Immune compromised individuals i.e. organ transplant recipients, HIV patients, cancer patients undergoing chemotherapy

CMV may be shed in the bodily fluids of any previously infected person, and thus may be found in urine, tears, semen, breast milk, saliva and blood. The shedding CMV virus may take place without any detectable signs and/or symptoms.

The incidence of primary CMV infection in pregnant women in Europe varies from 1% to 3%. Healthy pregnant women are not at special risk for disease from CMV infection. When infected with CMV, most women have no symptoms and very few have a disease resembling mononucleosis. However, their developing unborn fetuses may be at risk for congenital CMV disease. CMV remains the most important cause of congenital viral infection in Europe.

For infants who are infected by their mothers prior birth, the following potential problems exist:

• Whereas, Infants who are infected without symptoms at birth will subsequently have only a 5% -10% chance of developing the same complications.
   
• Infants who are infected at birth may present with symptoms including moderate enlargement of the spleen and/or liver, jaundice and even death. These infants that have symptoms have an 80% -90% chance of future complications during the first several years including: vision impairment, hearing loss, and mental retardation.

Fortunately, these risks appear to be almost exclusively associated with women who have not been previously infected with the virus and are experiencing their first infection with the virus during their actual pregnancy.

Primary CMV infection in the immune compromised patient can cause serious disease. However, the more common problem is the reactivation of the dormant virus. Infection with CMV is a major cause of disease and death in immune compromised patients, including organ transplant recipients, patients undergoing hemodialysis, patients with cancer, patients receiving immunosuppressive drugs, and HIV-infected patients. Pneumonia, retinitis (an infection of the eyes), and gastrointestinal disease are the common manifestations of disease. Because of this risk, exposing immune suppressed patients to outside sources of CMV should be minimized. Whenever possible, patients without CMV infection should be given organs and/or blood products that are free of the virus.

Currently, no treatment exists for CMV infection in the healthy individual. Antiviral drug therapy is now being evaluated in infants. Ganciclovir treatment is used for patients with depressed immunity who have either sight-related or life-threatening illnesses. Vaccines are still in the research and development stage.