Genital Herpes

What is genital herpes?

• It is a sexually transmitted infected caused by the herpes simplex virus (HSV).
• There are 2 types of HSV: type I and type II.

How do I catch genital herpes?

• Sexual intercourse with an infected individual
• An infected partner may not have noticeable erosions.
• Transmission from the mother to the child can take place upon delivery when the baby passes through the birth canal.
• There are two presentations of genital herpes:

1. primary herpes (first episode)
2. recurring herpes.

What is primary herpes?

• Primary infection is usually more severe in its presentation and lasts longer than recurring herpes. It usually lasts between 2 and 3 weeks.
• Small blisters (vesicles) are the first manifestation.
• Small blisters (vesicles) then rupture and leave place to erosions (superficial ulcers) in the genital/anal area.
• Swelling of the inguinal lymphatic nodes.

What is recurring herpes?

• Recurring herpes is generally less severe in its clinical presentation than primary herpes. It generally heals after a week.
• Recurring herpes can be preceded by itching and irritation at the same place where the blisters (vesicles) will appear.
• Not all HSV infected individuals have recurring attacks although it is impossible to predict who might have them and how often they might occur.
• Generally, recurring herpes attacks become less and less frequent (they are more spaced out).
• Herpes Simplex recurs because the virus hides in the nerve roots and reappears periodically to induce the signs and symptoms of this infection.

What happens to pregnant women with genital herpes?

• Infected mothers can transmit the infection to their babies.
• The baby can be infected during the delivery when passing in the birth canal (vagina).
• Mothers should inform their obtetrician or physician to determine the best way to deliver (through the birth canal, caesarean section…).
• Herpes Simplex infections in the newborn can be serious (blindness, mental retardation…).

How is genital herpes diagnosed?

• Genital herpes is often clinically evident.
• Viral culture allows to confirm the diagnosis. However, culture kits are not available in all medical centres.
• Another test called Tzanck’s test is available. It consists of microscopic examination looking for special cells in the infected liquid taken from the vesicles.
• Other tests are available such as direct immunofluorescence which examines a sample taken from the base of a blister.
• Certain blood tests called serologies are available to detect a previous infection by HSV.
• Many people have had labial herpes (cold sores) (oral herpes) which is often caused by HSV type I. Blood serology will therefore be positive for HSV type I, but it does not mean that they had genital  herpes (type II). Anyways, oral and genital herpes can both be causes by HSV types I or II.
• Blood serology only becomes positive 6 weeks after the infection.

Can genital herpes be cured?

• No, genital herpes cannot be cured.
• However, the infection is not deadly (lethal) in adults.
• Any treatment is targeted at the attacks (to prevent or treat an attack).
• Oral antiviral agents such as acyclovir, valacyclovir and famciclovir are useful to diminish the severity of the attacks if they are given rapidly.
• They are usually always prescribed for a primary herpetic infection.
• Oral antiviral drugs can also be given to suppress or space out the timing of recurrent attacks. This is useful for patients who have attacks quite frequently (every month or every two months). However this treatment does not enable eradication of the virus.
• To this day, no drug stops or spaces out the attacks in a permanent way.

What must I do if infected?

• See a medical doctor as soon as possible.
• Refrain from  any sexual intercourse until the lesions have healed.
• Do not self-medicate.
• Pay attention to the prodromal symptoms before the attacks. They may signal a recurrent attack which will be controlled faster if treatment is begun early.
• Condoms reduce the risk of catching/transmitting the infection.
• Ask the advice of a specialist (obstetrician or paediatrician) if you have any questions regarding a future pregnancy and the risks of transmission to your children.

How can I practice a “safer sex attitude”?

• It is a sexual intercourse with no contact between the secretion fluids (vaginal secretions, sperm).
• Use condoms (male or female available) for each sexual intercourse.
• Do not consume alcohol before or during the sex act as it could impair your judgment.

Contributors

Dr Husain Ali Mahdi Juma  (دكتورحسين علي جمعه) – dermatologist. Manama, Bahrain

National Skin Centre. Singapore