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What’s The Big Deal?

Genital herpes is not life threatening in and of itself. But having herpes sores makes it easier for HIV, the virus that causes AIDS, to enter your body. Not only is there an increased risk for getting HIV if you have genital herpes, but having the two diseases together may also make each one worse.

A pregnant woman can pass genital herpes on to her baby, so it’s particularly serious during pregnancy. If you get infected near the end of pregnancy, the risk is highest. At least 30% and as many as 50% of newly infected pregnant women give the virus to their babies. For moms who were infected long before delivery, the risk is much lower. Less than 1% of babies born to mothers with an older genital herpes infection get the virus. And if a woman has an outbreak at delivery, a cesarean delivery is usually done.

You may have heard that genital herpes causes cervical cancer. That’s not exactly true. It may be a factor, but it’s not the main cause.

Genital herpes is a lifelong condition for which there is no cure. Having it can force you to make inconvenient changes in your life, particularly in your sex life, and it can cause you a lot of pain and discomfort. You simply would rather not have it.

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The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea, chlamydia, and trichomoniasis. Genital ulcer diseases and human papillomavirus (HPV) infections can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes, syphilis, and chancroid only when the infected area or site of potential exposure is protected. While the effect of condoms in preventing human papillomavirus infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.

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Babies. Babies infected before birth who become sick with CMV have symptoms affecting many major organs including the liver, brain, eyes, and lungs. The baby may suffer from convulsions, lethargy, a rash that looks like tiny red pinpoints on the skin, and breathing problems. Surviving babies often have such permanent damage as mental retardation, small brain or water on the brain (micro- or hydrocephalus), hearing loss, eye inflammations, poor coordination, and liver disease.

Children. Young children have few, if any symptoms. They may experience a mild cold- or flulike illness with fever, but you can’t tell it apart from any other mild viral illness.

Adults. Very few adults, including pregnant women, have any symptoms. Symptoms will be so mild—achiness, a low fever, sore throat—that you won’t be aware you are sick.

Tests

Because the virus is excreted in blood, urine, saliva, cervical secretions, and breast milk, CMV can be grown in any of these samples. It is not difficult to grow the virus, and the test is available in most large hospital and commercial labs. The virus grows slowly, however, and you may wait from two to six weeks for results.

You can also have your blood tested for the CMV antibody. If you have the antibody, you’ve been previously infected with CMV, but this test won’t tell whether the virus is present in your blood, urine, or saliva.

Newborns with possible congenital CMV infection must have virus cultured from their urine, nose, eyes, or spinal fluid to confirm CMV as the cause of illness.

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You catch CMV from close, intimate contact with infected urine; saliva; respiratory, vaginal, or cervical secretions; breast milk; or semen. It can be sexually transmitted, but most people get CMV through close household contact. Poor people are much more likely to be infected as young children, probably because they live in crowded conditions.

Babies get it from their mothers before birth, during delivery, or in the first few weeks of life. The baby is infected during pregnancy if its mother has either a first-time CMV infection or a reactivation of a past one.

Women who have toddlers attending child care are often infected. CMV transmission is rapid in these places because urine and saliva are passed from child to child on dirty hands. Young children rarely have symptoms, but they excrete the virus in their urine and saliva for months to years. Anyone working in child care or in any area with lots of young diapered children is exposed to CMV.
It is often transmitted from blood transfusions because so many people, including blood donors, have CMV infections with no symptoms.

Most people are infected with CMV before they reach adulthood, but very few people experience any symptoms or signs of illness. People with AIDS and organ transplant recipients are at highest risk for serious CMV infection—either pneumonia or retinitis, an eye infection. Often, their own latent CMV infections will reactivate as their immune systems either weaken or are suppressed by drugs to prevent organ rejection.

People who need organ transplants are tested for antibodies to CMV. Doctors will try to match CMV-negative organ donors to CMV-negative organ recipients. But a match isn’t always possible and the CMV-negative organ recipient faces a risk of serious CMV infection from the transplanted organ weeks to months later. To prevent this, the doctor will give the transplant recipient an injection of CMV antibody.

CMV-negative organ recipients who need blood transfusions will receive CMV-negative blood. This blood is hard to come by and is saved for people who really need it. If no CMV-negative blood is available, the blood can be filtered to remove the cells containing CMV. Otherwise, transplant patients may become ill if they receive CMV-infected blood.

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If Ted Kennedy’s cancerous lesion is a glioblastoma multiforme, the most common kind of brain tumor, it may have been caused by a virus from the herpes family.

Last year, Duane Mitchell and his colleagues at Duke University learned that cytomegalovirus is present at elevated levels in more than 90 percent of glioblstoma multiforme tumors. Armed with that knowledge, they are testing a vaccine that fights the common virus as a brain-cancer remedy.

Their patients also receive standard cancer treatments a staple in the treatment of some gliomas, that may also enhance the effects of the vaccine.

Mitchell is testing daclizumab, an antibody that can suppress the immune system, in combination with the vaccine. When the natural defenses bounce back after being knocked down by the drug, they may more vigorously attack the cancer-causing virus.

Brain tumors are not the only type of cancer that can be caused by a virus. Most cases of cervical cancer can be prevented by taking the vaccine Gardasil, which wards off human papillomavirus.

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