Genital herpes

With its characteristic genital ulcers, genital herpes is the most widespread sexually transmitted disease in the world. The pathogen is the herpes simplex virus, types 1 (HSV-1) and 2 (HSV-2). Both types can cause symptoms on the genitalia, but experience shows that the type 1 virus generally causes a somewhat milder primary infection and fewer flare-ups with milder progression.

Symptoms of genital herpes

The first occurrence of infection by the virus results in symptoms of primary genital herpes in some cases. Pain, redness, later multiple blistering or ulceration appears 3-12 days following infection in the genital area and surrounding the anus, depending on the site of infection. The surrounding lymph nodes become swollen and painful, and difficulty in urination and bowel movements may be experienced. These symptoms may be accompanied by fever and general symptoms (malaise, headache, despondency). Without treatment, symptoms persist for 1-3 weeks, with frequently occurring superinfection by bacteria and yeast in the resultant ulcers (discharge, putrid secretions). Men may experience symptoms of urethral inflammation (urinary complaints, discharge) in addition to the changes seen on the penis.

The infection with the virus can also be symptom-free or present with milder symptoms. Following infection, the latent (inactive) virus can lodge itself in the sensory nerve ganglia, emerging and multiplying in response to various “trigger factors”, causing symptoms of recurrent herpes. These trigger factors can be stress, physical trauma (even sexual intercourse!), menstruation, fever, sunlight, other infections. The frequency of flare-ups and their severity can vary significantly from patient to patient, and is a function of the persistent virus and the condition of the host’s immune system.

Diagnosis

The diagnosis is based primarily on the clinical symptoms. Physicians specializing in STD (sexually transmitted diseases) have the most experience. It is currently possible to detect the existence of the pathogen in symptomatic patients using PCR (Polymerase Chain Reaction) techniques. In doubtful cases, the venereologist will weigh the other possible causes (e.g., syphilis and other causes of lesions) when setting up a diagnosis.

The treatment of genital herpes

In addition to the use of local disinfectant and an epithelialization agent, systemic antiviral medication is necessary to treat a primary infection. Outbreaks are managed by use of short-term treatments with antiviral medications.

Important information

It is important to understand that an asymptomatic virus carrier can be the source of the infection; in other words, not only patients with symptomatic recurring herpes, but also asymptomatic patients may shed virus and can therefore be infectious. For these patients, sexual abstinence during symptomatic periods, and the use of prophylactics (condoms) during asymptomatic periods is recommended. Given that the HSV-1 can cause genital herpes symptoms as a result of orogenital contact, the recommendations above apply to oral herpes patients as well.

Due to the potentially fatal consequences, perinatal infections are extremely dangerous. The mortality rate due to herpes infection acquired in the birth canal (encephalitis, sepsis) is very high (50%). In the event that genital herpes symptoms are observed around the due date in mothers with recurring herpes, Cesarean section is required. If the sexual partner of a pregnant woman has recurring genital herpes, they must be informed that primary infection of the fetus by herpes can be dangerous and that infection during pregancy should be avoided through the use of condoms. If the sexual partner suffers from oral herpes, oral sex should be avoided during pregnancy.