Genital Herpes

TREATMENTS OF SEXUALLY TRANSMITTED DISEASES

Genital Herpes

More than 12 percent of the world population suffers from some type of herpes with genital affection, according to data provided by the World Health Organization during the year 2015, which is why it constitutes a major health problem at the international level.

Genital Herpes

Table of Contents

definition

What is genital herpes?

Genital herpes is the most common sexually transmitted ulcerative infection in developed countries, including Spain.

More than 12 per cent of the world’s population suffers from some type of genital herpes, according to data provided by the World Health Organization during 2015, making it a major international health problem. Genital herpes is produced by Herpes Simplex Virus type 2 (HSV-2), but it has also been observed that HSV-1 (generally associated with cold sores) can infect the genital mucous membranes and cause the disease.

Transmission occurs through contact with surfaces of skin infected with the virus, often during unprotected sex. Infected skin may appear asymptomatic and still transmit the infection.

Also, a woman who is pregnant and has HSV-2 can transmit the virus to the newborn during childbirth, with neonatal HSV infection being a serious and potentially fatal infection.

Symptoms of advanced genital herpes may include malaise, similar to a common cold, and numerous small, painful blisters on the genitals’ skin (on the glans, penis, and foreskin in men, and the labia, vulva, and vagina in women). These blisters may also occur in the perianal area (around the anus and rectum) if the infection occurred during anal intercourse.

The diagnosis of this disease consists of clinical evaluation of the patient, serological and molecular tests, such as PCR (or Polymerase Chain Reaction) which has a high level of reliability.

Treatment consists of the administration of antiviral medications to decrease the viral load in the body and inactivate the infection.

Frequent causes

How does the virus work?

Herpes simplex virus type 2 is the causative agent responsible for genital herpes, an infectious and technically incurable disease because the virus can remain dormant for years or even decades.

This virus is part of the herpesviridae family, the same family in which the causative agent of shingles disease (or chickenpox) or cold sores, which affects many people, is found.

How it is trasnmitted?

It is transmitted from person to person by direct infected skin contact, even without the presence of blisters or tissue damage. This occurs during vaginal, anal, or oral sex.

Genital lesions may not develop, but even so, the skin in this area remains a focus of infection.

During a latency period, the virus actively proliferates within the inguinal lymph nodes.

However, it’s in the ulcerous and blistering lesions of the genitals’ skin that the virus is most concentrated.

Body fluids such as saliva, vaginal and seminal secretions, suppurative fluid from genital ampoules and blood may contain and transmit this virus.

Also, a pregnant mother infected with genital herpes can infect her child during labour. This is known as vertical transmission.

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symptomatology

What are its symptoms?

Very often, genital herpes does not cause noticeable symptoms during its early stages, so many people are unaware that they have it, increasing the spread to others.

Initial genital lesions begin to develop about four to seven days after infection from infected skin contact. These lesions appear as a group of very painful small vesicles (or blisters) that, when rubbed against underwear, can form even more bothersome ulcers.

These injuries take place in:

These lesions are quite painful and cause discomfort during urination or sexual intercourse.

Blisters that become ulcerous can heal in a couple of months, leaving a fibrous skin surface (that is, thicker and harder than the adjacent skin).

In nearly 80 per cent of patients, these lesions may recur even years after they were healed.

Also, these lesions can cause co-infections with other bacteria such as staphylococcus and produce general malaise similar to that which occurs when there is a common cold or flu process (fever, joint and muscle pain, weakness, headaches, etc.). Lesions in the genitals by initial HSV-2 are usually more painful and lasting compared to those that occur during the latency period of the virus. Also, they are more likely to involve the lymph nodes in the groin region, increasing in size and causing pain on palpation.

Can a contagion be asymptomatic?

Indeed, the virus can incubate for almost a week, during which time there are no apparent symptoms or general malaise.

Can a contagion be asymptomatic?

There are no relevant differences between HSV-2 infections in men or women. The lesions are the same and the risk of infection is the same.

Medical evaluation

Risk factors

Having excessively promiscuous sex without knowledge or certainty of their health history and especially without the proper use of latex condoms, greatly increases the risk of getting genital herpes.

How to prevent it?

To prevent the spread of genital herpes, it’s necessary to abstain from any type of sexual contact (vaginal, anal or oral sex) with infected people, paying special attention to strangers. It is possible to maintain safe sex with previously tested partners.

The correct use of latex condoms is a great help to reduce the risk of infection. However, it should be noted that condoms do not offer completely safe protection because they do not cover all surfaces of infected skin.

However, a patient with genital herpes should be responsible and abstain from any type of sexual intercourse in which there is skin and mucous membrane contact, even if they are not showing the symptoms of the disease.

diagnosis

How is it diagnosed?

Genital herpes is almost always diagnosed by clinical methods, i.e. the evaluation of lesions in the doctor’s practice. Although several sexually transmitted infections produce ulcerous blisters, genital herpes blisters are quite characteristic.

In other cases, genital lesions are not well defined or are simply not there (latent disease or incubation period) and for this, specific HSV laboratory tests are used to help confirm or not the diagnosis.

These tests begin with taking a sample of the suppurative fluid from the genital blisters or ulcers, with a cotton swab (swab). The HSV culture helps to confirm whether or not there is a genital herpes viral process.

However, the absence of HSV in the test does not necessarily mean that there is no genital herpes problem because the virus can be found decreased in the lesion but latent elsewhere, such as in lymph nodes.

Serological tests also help in the detection of genital herpes by measuring the specific antibodies for HSV-2 (and also HSV-1). These antibodies are developed by the patient’s own immune system when these viruses are present.

The polymerase chain reaction (or PCR) method offers greater accuracy in terms of results and is therefore increasingly used. With this technique, the causative agent is identified from its own genetic material.

Techniques and treatment

How to treat the disease

This disease is treated with antiviral drugs, such as Acyclovir, Valaciclovir, and Famciclovir.

These drugs are specific to treating the herpes simplex virus, so they don’t work in other viral infections.

The administration of these drugs is oral or intravenous, the latter being a better way to eliminate the foci of virus in genital lesions, as it would be transported directly through the bloodstream.

These three drugs decrease viral load and lessen symptoms such as the pain of genital lesions. However, they do not prevent future relapses of the disease.

In recurrent lesions, the dose of antiviral drugs is usually higher but in a shorter treatment time.

Are there any re-infections after treatment? Until when is it still transmissible?

Genital herpes is caused by a virus that is very difficult to eliminate completely from the human body. For this reason, it remains transmissible for life.

The pharmacological treatment decreases the viral load and therefore, the risk of being infected.

The habitual and adequate use of condoms provides 50 per cent protection against the spread of herpes and, together with pharmacological treatment and constant medical check-ups, allows a person to enjoy an active sexual life with certain restrictions.

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Frequent questions

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What are the most serious complications?
If infection with herpes simplex virus type 2 is not adequately treated for a very long time, or if the person has an immunosuppressive disease (such as HIV), life-threatening complications can occur. Among the most common complications are aseptic meningitis and neonatal herpes.
Is neonatal hsv-2 infection preventable?

It’s somewhat difficult to prevent a newborn child with an infected mother from getting the disease.

In any case, within prenatal care there are tests for this infection because of the great risks to the life of the newborn.

If the pregnant woman develops symptoms similar to genital herpes (or has suffered it before) is recommended cesarean delivery, to prevent the newborn has direct contact with the female genital organs.

In addition, this group of patients (pregnant women) can receive treatment with antiviral drugs from the 36th week of gestation.

Before this period, there is a risk of fetal damage.

If i am infected, can i have sex?

That is not recommended. However, the treating physician will be responsible for giving specific instructions for the patient to have sex with a decreased risk of transmissibility.

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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