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Genital Herpes

Overview

Genital Herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV 2). Generally, the infection does not result in apparent signs and symptoms. They might be mild or even absent. It causes burning, tingling, sores, blisters on the skin, and mucous membranes when symptomatic. It can be divided into infections above the waist involving the mouth and the tongue usually caused by HSV1 and those below the waist involving the genitals caused by HSV 2. Once infected, the virus remains in your body and can cause a recurrent infection when triggered. Genital herpes can not be eradicated, but medicines or home remedies control the symptoms, and spread is prevented by using condoms. 

Causes

Having unprotected sex causes the herpes simplex virus to transmit. Although Herpes is most contagious when virus-filled lesions are present, it can also spread by asymptomatic shedding, which means Herpes virus can be in the saliva or the genitals secretions even when there are no signs of cold sores or genital lesion and can be transferred from one person to the other.

Typically, when herpes is contracted by a person who has never had the virus before, it dives into the skin's small cracks, which internalize it. The virus remains dormant until triggered. The recurrent episodes vary in severity from mild to severe and are triggered by stress, skin damage, and viral illnesses.

HSV can also be transmitted at birth when the baby passes through maternal vaginal secretions, which may cause skin, eye, and mucus membrane lesions in the baby after delivery, typically at the site of damaged skin. It may cause a very severe disseminated illness resulting in seizures, lethargy, or irritability in babies as well.

Types

There are two types of herpes virus capable of causing genital herpes. Herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). 90% of genital herpes are due to HSV-2 infection, whereas 10% result from HSV-1. Both HSV-1 and HSV-2 are structurally similar.

Risk Factors

  • More than one sexual partner
  • Immunocompromised individuals
  • Infants with infected mothers
  • Sexually abused children
  • Females are at more of a risk to have genital herpes.

Epidemiology

Genital herpes is one of the most prevalent sexually transmitted diseases. In 2015, it affected 12% of the people around the globe. One million cases are diagnosed annually in the U.S alone.

Signs And Symptoms

The infection is sometimes asymptomatic. Patients may complain of headaches, fever, body ache, enlarged lymph nodes, and cold sores during the first outbreak that may take up to six weeks to heal fully. The most common symptoms are;

  • Pain in the genital area
  • Pain during urination
  • Itching in the genital area
  • Tingling and Burning sensation in the genital area
  • Blisters (small, painful fluid-filled blisters in the genital area )
  • Ulcers pustules on genitals
  • Inguinal lymphadenopathy
  • It may cause unusual symptoms in immunocompromised individuals.

Differential Diagnosis

Several conditions may resemble the infection of genital herpes

Diagnosis

If you have symptoms, consult your healthcare provider. You may need to consult in a clinic specific for sexual infections. The doctor will take the history of your symptoms, sexual contacts, previous episodes, and other sexual infections. They will perform the physical examination, emphasizing the genital area or the lesions. Your doctor might take scrapings from the lesions to send for laboratory analysis. The following tests are done to identify the organism;

  • PCR to look for viral DNA
  • Culture: Primary test in most settings
  • Direct fluorescent antigen (FA): Some don't provide virus type.
  • Cytology (Tzanck prep)
  • Serologic testing: testing for antibody against HSV

Treatment

  • Although infections typically resolve without treatment, antiviral drugs such as Acyclovir, Famciclovir, and Valacyclovir are used topically or systemically to reduce pain and speed healing, best if taken before blisters appear.
  • High-dose intravenous antivirals are given for severe cases.
  • Amino acid supplements like lysine and arginine have been beneficial
  • Symptomatic relief of pain, burning, and itching pain-relieving creams such as lidocaine.
  • Patient support and counseling are essential as the patients suffer from anxiety, depression, and social withdrawal.
  • A more conservative approach to treatment is to use ice packs wrapped in towels, avoid tight clothing, warm sitz bath (colloidal oatmeal soap or bath treatments may also be soothing ), essential oil lemon balm, and abstinence during outbreaks. 

Prognosis

Most HSV infections are self-limiting. Life-threatening conditions include neonatal herpes, herpes encephalitis, HSV infections in immunocompromised patients, and severely malnourished infants and children. Recurrent ocular herpes can lead to corneal scarring and blindness. HSV infections are temporary and resolve without a detrimental sequel for most people. Unfortunately, recurrence is common. The pain and discomfort and the psychological impact of the outbreak cause morbidity to individuals who are affected. Having genital herpes makes it easier to get HIV (and thus AIDS), but otherwise, it is not disabling and does not reduce the lifespan of individuals. 

Prevention

Practicing safe sex, i.e., the use of condoms during sexual contact and dental dams during oral, anal, and vaginal sex, limits the virus from spreading. However, there may be sores on places the condoms don't cover. A person who suffers from genital herpes must inform their partner and consult their doctor so that the doctor can advise a treatment plan. A mother who is expecting must inform their doctors before delivery. The doctor may recommend a C section so that the newborn is not infected with the virus. A healthy diet and vitamins with adequate sleep and stress management will make the herpes outbreaks less frequent. Topical Salves for Herpes 1 and 2 are aloe vera, Epsom, coconut oil, neem, lemon balm, propolis, manuka honey, tree tea oil, and zinc for relief from symptoms. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on April 20th, 2023.

References

https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/genital-herpes#:~:text=Genital%20herpes%20is%20a%20sexually,the%20mouth%20(type%201).

https://www.sciencedirect.com/science/article/abs/pii/S0140673607619084