What is Genital Herpes?
Herpes simplex (HSV) was first reported over 2,000 years ago, but was not identified as a virus until the 1940s. There are two types, HSV type 1 (HSV1) and HSV type 2 (HSV2). HSV 1 is usually associated with infection of the mouth, throat, face, eye and nervous system. HSV2 is usually sexually transmitted and causes genital infection.
Each strain, however, may cause infection in all areas, as cross infection of HSV 1 and HSV 2 may occur from oral-genital (oral sex) contact. This means that one can get genital HSV in or on the mouth, and oral HSV in the genital area. HSV can also affect the hands (called a whitlow) but more seriously can affect the eyes, or invade the central nervous system (encephalitis).
Furthermore, patients with immature or suppressed immune systems, such as infants, transplant patients, patients with advanced HIV disease or pregnant women are prone to severe complications from HSV.
How does one get Genital Herpes?
HSV is contracted through direct contact with an ulcer or body fluid from an infected person.
The virus travels through tiny breaks in the skin or mucous membranes in the mouth or genital area. Asymptomatic shedding may also occur, where the infected person shows no visible signs of the disease but is still infectious. Such asymptomatic shedding is commoner in HSV2, and in the first 12 months of the infection. Barrier methods of contraception, such as condoms, reduce but do not eliminate transmission risk.
What are the signs and symptoms of Genital Herpes?
HSV of the mouth and face is readily identified by its clinical appearance, usually multiple, round ulcers filled with straw coloured fluid. Genital HSV may be more difficult to diagnose, as many do not have the classical blistering rash. It may also be mistaken for other genital conditions, including fungal infections, and the chancre (ulcer) of primary syphilis.
Primary (first time) genital HSV1 and HSV2 are characterised by ‘systemic’ symptoms, fever, headache and malaise. These symptoms are usually worse within the first few days of the appearance of the rash, and gradually recede in 3-4 days. Pain in the genitals or when passing urine, itching, discharge from the vagina or urethra reach a maximum at day 7-11 of the infection. Swollen glands in the genital area may also occur, and can take several weeks to resolve.
In an attempt to kill the virus, the body makes antibodies to HSV1 or HSV2. These antibodies do not kill the virus however, and it travels to the base of the nerves in the skin, where it remains latent (dormant) and has lifelong ‘residency’. During this latency period, no virus is produced, and the patient is well and symptom-free. Most patients, however, experience recurrences of the ulcer. In the lead up to the ulceration, the patient may experience tingling in the area, itching, and pain in the skin. During these recurrences, the ulcers are usually less painful and heal faster than the primary infection, but for others they may still be quite debilitating. The recurrences are commoner in HSV 2 than HSV1, and are believed to be triggered by local trauma, menstruation, ultra-violet light and sunlight.
How is Genital Herpes diagnosed?
Tests can be done to confirm HSV infection.
Viral culture, or search for viral genetic material (PCR) from the rash, or antibody tests in the blood if past infection is suspected.
How is Genital Herpes treated?
There is no treatment currently available to eradicate the virus, but many cases of HSV infection are mild and do not need treatment. For the minority with a severe or prolonged occurrence, especially if it’s the first episode, if there is a high frequency of episodes, or if the patient is immunocompromised, antiviral medications may be prescribed. Those with frequent or severe recurrences may choose to take antiviral medication daily, termed ‘suppressive’ therapy, to prevent recurrences, or during each episode for three days.
Is there any aftercare for Genital Herpes?
Patients infected with HSV may feel stigmatised by the infection, and may very occasionally need psychological support. The reality is, however, that the vast majority of the world’s population are carriers of HSV1, HSV2 or both, and most people have no symptoms at all. Using emotive and anxiety-provoking terminology such as ‘attacks’ and ‘outbreaks’ may fuel such stigma, and should be avoided. HSV infection in pregnancy, or in the immunocompromised, is very serious and merits expert attention.
How is Genital Herpes prevented?
Genital herpes is best prevented by avoiding sex during an episode of the rash. Consistent and correct latex male condom use is also essential.
Preventing infection during pregnancy is also essential. Infection of the infant commonly occurs by direct contact with the blisters in the birth canal. This is most often in women who are newly infected in advanced pregnancy.