A Quick Reference Guide to Common Conditions Related to Sexual Health, Part 2: Viruses

Maintaining sexual health is a significant factor in our overall well-being, involving the physical, emotional, mental, and social aspects tied to sexuality. It's all about respecting, protecting, and managing our sexual rights while striving to steer clear of diseases. Dealing with unexpected infections, courtesy of various pathogens, is a common hurdle in sexual health. Prioritizing our patient's sexual health is vital for a fulfilling sex life and tackling any health concerns, such as viral infections, that may pop up along the way. Being savvy about these infections is crucial for keeping our sexual well-being in check and maintaining good health overall.

Today, we're taking a closer look at the viral infections that can affect our sexual health.

Human Immunodeficiency Virus (HIV) 

Let's start with human immunodeficiency virus (HIV), which targets the immune system. Contrary to popular belief, it's not a new virus. Sometime in the late 19th century, HIV moved from chimpanzees to humans, likely due to contact with infected blood from hunting and consuming infected meat. In the 1980s, HIV became a major health epidemic and gained media attention around the world. At the time, it was called gay-related immune deficiency (GRID) as it was believed to only affect men who had sexual intercourse with men.  

Since the 1980s, we've gained a lot of knowledge of how HIV is transmitted. We now know that transmission happens through contact with certain body fluids, like semen or pre-seminal fluid; vaginal or rectal fluids; blood; and breast milk. So, transmission can occur from activities like unprotected vaginal or anal sex, sharing needles, blood-related rituals or practices, or breastfeeding.  

HIV infection goes through three distinct stages: acute, chronic, and acquired immunodeficiency syndrome (AIDS). The acute stage occurs approximately 2-4 weeks after exposure to the virus and manifests with flu-like symptoms such as fatigue, chills, body aches, fever, rash, sores in the mouth, night sweats, or swollen lymph nodes. During this stage, the virus rapidly divides, spreads, and attacks immune cells, called CD4 or T-helper cells, which are responsible for helping our bodies fight off infections.  

Next is the chronic stage, when the virus continues to divide and spread but not as rapidly. Some individuals in this stage might not even have any symptoms.  

Lastly, if HIV goes undetected or untreated, it can progress to AIDS. AIDS is a severe deficiency of immunity defined as a CD4 count less than 200 cell/mm3 and makes the individual easily susceptible to many opportunistic infections.  

HIV is typically diagnosed using blood tests, including antibody, antibody/antigen, and nucleic acid. Additionally, some HIV tests use urine or saliva rather than blood. You can even buy at-home rapid self-tests online or at a pharmacy or obtain mail-in tests where you can send a sample to a lab for testing.   

The good news is that since discovering HIV, we have advanced its treatments drastically. These treatments can prevent infection with HIV, minimize progression to AIDS, and, if taken appropriately, can even significantly reduce transmission of the virus.  

If a patient engages in high-risk activities where they're more likely to encounter HIV, such as having unprotected sexual intercourse with multiple partners. In that case, they can be prescribed pre-exposure prophylaxis (PrEP). PrEP medications are antiretrovirals that HIV-negative individuals can take to prevent acquiring the virus. PrEP includes a combination of the oral medications tenofovir disoproxil fumarate and emtricitabine, tenofovir alafenamide and emtricitabine, or the injectable cabotegravir. Similarly, post-exposure prophylaxis (PEP) is an antiretroviral that HIV-negative individuals who have a suspected or known exposure to HIV within the last 72 hours. These include a combination of tenofovir, emtricitabine, and either raltegravir or dolutegravir. Lastly, for those who are HIV-positive, treatment consists of antiretroviral therapy (ART), which involves a combination of medications that attack viral replication at different stages. There are a wide variety of combinations, and patients may go through various adjustment periods to determine what works best. When taken as prescribed, ART can reduce the viral load, or amount of HIV in the blood, to nearly zero, which makes transmission of the virus also nearly zero!  

Prevention of HIV

To prevent sexual transmission of HIV, you can use latex condoms during sexual activity, limit sexual partners, get routine HIV screening tests, and talk to your healthcare provider about PrEP or PEP, as needed.   

Hepatitis B 

Hepatitis B, an inflammation of the liver, has been present in humans for at least 10,000 years. There are a lot of different types of hepatitis, including those that are infectious and those that are non-infectious. We're going to focus on hepatitis B, caused by infection with the hepatitis B virus (HBV), which is even more infectious than HIV! HBV can be transmitted through sexual activity, like vaginal or anal intercourse, as well as through blood, like sharing needles, and from mother to baby during delivery. 

Infection with HBV can be acute or chronic. Acute infections present about 90 days following exposure, though some individuals may not even know they're infected. Signs and symptoms can include dark-colored urine, clay-colored stools, fatigue, fever, joint pain, GI upset (e.g., nausea, vomiting, diarrhea), and jaundice, which is yellowing of the skin and eyes. On the other hand, individuals with chronic HBV infection may not have any signs or symptoms at all! However, they can still pass the infection on to others.  

Diagnosis of HBV infection is made using three blood tests: HBsAg, anti-HBs, and total anti-HBc. These tests identify the presence or absence of HBV antigens and antibodies. They can tell if someone is vaccinated and protected from HBV, acutely infected, chronically infected, or if they've had HBV in the past that has resolved.   

Acute HBV is treated with supportive care like rest and hydration, and most cases will resolve on their own. If chronic HBV develops, there's no known cure, so treatment includes supportive care such as following a healthy diet, exercising, limiting alcohol use, and seeing a healthcare provider for routine check-ups. Some individuals with chronic HBV may be prescribed antivirals such as pegylated interferon or entecavir or the antiretroviral tenofovir disoproxil fumarate.  

Prevention of Hepatitis B

HBV can be prevented with the HBV vaccine, with the first dose being given at birth or in adulthood for those at risk. Additionally, the use of condoms during sexual activity can limit transmission.  

Herpes Simplex Virus 

Present in humans between 1.4 and 3 million years ago, the HSV2 virus crossed over from African apes to our ancestors. Like hepatitis, there are a variety of herpes viruses, but today, we're going to focus on herpes simplex virus or HSV. HSV has two types: type 1 (HSV-1), which is typically associated with cold sores, and type 2 (HSV-2), which is typically associated with genital herpes.  

HSV-2 is transmitted through sexual contact, including vaginal, anal, or oral intercourse or touching. It is important to note that HSV-1 can also cause genital herpes if an individual with HSV-1 engages in oral-genital contact.

HSV-2 can be asymptomatic or present with breakouts of small, painful blisters or ulcers that tend to recur. Sometimes, there may be a tingling sensation, itching, or burning in the affected area before a breakout. 

Diagnosis of HSV-2 can be made using a blood test to detect HSV-2 antibodies or a polymerase chain reaction (PCR) test using fluid swabbed from a burst blister.  

HSV-2 is a lifelong condition, so treatment focuses on minimizing breakouts using antivirals like acyclovir. For some, treatment may be needed intermittently for breakouts, while others may take it daily to prevent breakouts.  

Prevention of HSV

Prevention of HSV involves using condoms and dental dams and limiting sexual partners. 

Human Papillomavirus 

Human papillomavirus (HPV) consists of a large group of viruses transmitted through vaginal, anal, and oral intercourse and was first described back in 1949 after researchers viewed wart tissue under an electron microscope. Since then, we've learned there are over one hundred different low- and high-risk strains of HPV. Low-risk strains cause warts on the genitals, anus, mouth, and throat and have a low concern for progressing to cancer. High-risk strains tend to cause cervical, anal, or oropharyngeal cancers.  

Signs and symptoms of HPV infection include skin-colored warts that have a cauliflower-like appearance. They're typically painless but can itch, burn, or bleed. If an HPV infection has led to cancer, manifestations depend on the site affected and the progression of the disease.  

Diagnosis can usually be made through the physical examination of warts, if present. If unsure of the diagnosis or if there's concern for progression, remove and examine the warts microscopically. Additionally, HPV tests and pap smears can be done using scrapings from the cervix. HPV tests can identify the presence of HPV, while pap smears can identify changes in cells that might become cancerous if left untreated. Both HPV tests and pap smears are recommended screenings for anyone with a cervix.  

Treatment depends on the strain of HPV and if it's progressed. Thankfully, most low-risk strains of HPV will clear on their own and don't require treatment. Treatment for low-risk strains that cause warts can include topical medications such as imiquimod, cryotherapy, where lesions are frozen off with liquid nitrogen, or electrocautery, which removes lesions using electrical current. Additionally, surgical removal can be done. High-risk strains may require more intensive or frequent treatments or even treatment for cancer if the infection has progressed. 

Prevention of HPV

HPV can be prevented through the use of condoms and dental dams during sexual activity and vaccination, which ideally begins before individuals become sexually active. 

Molluscum Contagiosum 

Molluscum contagiosum is a skin condition transmitted through skin-to-skin contact. A common skin infection seen in children, it can also be transmitted through contact during sexual intercourse between adults. It's also possible for it to spread through contact with contaminated objects like towels or clothing or through autoinoculation by touching a lesion and spreading it to another part of your body.  

Signs and symptoms typically appear two to three months following exposure and include small, raised bumps with a depression in the middle. The lesions are flesh-colored, yellow, gray, white, or pink and are typically painless.  

Diagnosis is made using a physical examination by a provider. In cases where diagnosis is uncertain, a biopsy of the lesion can be taken and inspected under a microscope.  

Most cases of molluscum contagiosum resolve on their own. If necessary, lesions can be removed surgically or with topical treatments like phenol or iodine. Cryotherapy is also an option. 

Prevention of Molluscum Contagiosum

Zika Virus 

The Zika virus, a mosquito-borne virus first identified in monkeys in Africa in the 1940s, made the jump to humans in the 1950s and now causes sporadic infections. While infected mosquitoes transmit the Zika virus, individuals who've been infected can spread the virus through sexual contact, including vaginal, anal, and possibly oral contact.  

Signs and symptoms of Zika infection can include fever, rash, headache, arthralgias (i.e., joint pain), and muscle aches. Some individuals may also be asymptomatic. Signs and symptoms are typically very mild and resolve within a couple of weeks. However, if the Zika infection occurs during pregnancy, it's associated with complications such as congenital microcephaly and fetal loss.

Because most cases of Zika infection are mild, treatment is typically supportive with oral fluids for hydration, rest, and over-the-counter medications like ibuprofen or acetaminophen. In the rare case where Zika infection is severe, individuals can be treated in a hospital with intravenous fluids and supportive measures. 

Prevention of Zika

Zika virus transmission during sexual activity can be minimized by using condoms or dental dams during sexual activity.  

About the Author

Kelsey LaFayette, DNP, ARNP, FNP-C, Nursing Content Manager at Osmosis from Elsevier, obtained a Bachelor of Arts in Nursing degree from Luther College in 2011. As an RN, she has a clinical background in medical and pulmonary inpatient units, urgent care, and critical care, and obtained her Doctor of Nursing Practice degree at the University of Illinois at Chicago in 2022. Throughout her career, Kelsey has had many opportunities to function in an education role by being a charge nurse, preceptor to new RNs and nursing students, as well as a Clinical Team Lead in charge of creating orientation programs and policies. Through these opportunities, Kelsey realized her ideal career path should focus on the education of nurses, nursing students, patients, families, and anyone else with a desire to learn. Kelsey serves as a manager on the Nursing Content team and has been able to work on various projects that fulfill her love of perpetual learning.

Reviewer

Lisa Miklush, PhD, RN, CNS, Senior Content Editor

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