Genital Herpes

Content Reviewed by Dr. Gayatri Devi MBBS, DV (Venerologist)

What is genital herpes?

Genital herpes is an infection caused by the herpes simplex virus (HSV). There are two types of HSV. HSV type 1 usually infects the lips, causing cold sore but this virus can also infect the genital area. HSV type 2 is the virus which usually causes genital herpes, but it may infect the mouth during oral sex. A person who has genital herpes infection can easily pass or transmit the virus to an uninfected person, during sex. Both HSV 1 and 2 can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin. HSV remains in certain nerve cells of the body for life, and can produce symptoms, on and off, in some infected people.

How does a person get infected by genital herpes?

Herpes virus spreads by close direct contact. When HSV is active, the affected person usually has sores in the genital area, from which the virus is shed. Since the virus remains in the nerve cells near the skin, after the initial infection, it may still be shed in the abscence of any visible spores. In other words, if a person has suffered from one attack of HSV infection, he may remain infectious to others even in the abscence of obvious sores.

What are the symptoms of genital herpes?

Many people who have herpes, usually do not recognize the symptoms of the infection. The symptoms usually appear within 2 to 10 days of being infected. When a person is infected for the first time, the symptoms may last 2 to 3 weeks. Early symptoms of a genital herpes outbreak include: · itching or burning feeling in the genital or anal area. · pain in the legs, buttocks, or genital area. · discharge of fluid from the vagina. · feeling of pressure in the abdomen. Within a few days, sores appear near the mouth, penis, or vagina depending upon where the virus entered the body. Sores may be found even inside the vagina and on the cervix in women, or in the urinary passage of men and women. The lesions appear as small red bumps, which develop into blisters and become painful open sores. The sores may then become crusty and heal without leaving a scar. When a person is infected for the first time the symptoms may include fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin.

Can a person have repeated outbreaks of genital herpes?

After a person has the first infection of herpes, the virus travels to the nerves at the end of the spine where it stays inactive for a while, hidden in the nerve cells. From time to time, the virus may become active and travel along the nerves to the skin. It usually multiplies at the same site as during the first infection, causing a recurrence of symptoms.  Small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina. Because these lesions may not always cause pain, a person may not give them much thought. But such a person can still infect a sex partner during this time. Repeated infections of genital herpes are usually mild and last for about a week. Such infections can cause a tingling sensation or itching in the genital area, or pain in the buttocks or down the leg. These early symptoms could be painful. While no sores may be present, small blisters could appear and break into open sores that crust over and disappear. Some people may have one or two outbreaks in a lifetime. Others may have several outbreaks a year. It is not known why the virus becomes active again from the nerve cells. Patients sometimes associate a fresh recurrence with some other incidental illness, stress, or a menstrual period. Sometimes excessive exposure to sunlight is said to cause a recurrence. As the disease becomes chronic (long standing), the duration between the relapses also gets prolonged.

How is herpes diagnosed?

A doctor may be able to come to a diagnosis of genital herpes by physical symptoms including the culture tests or antigen tests can be done from the blister fluid to detect HIV. Laboratory tests may also be requested for. A blood test cannot reveal whether a person can infect another person with this virus. But it can show if a person has been infected at any time with HSV.

What is the treatment for genital herpes?

There is no permanent cure for genital herpes, but a doctor may prescribe these medicines to treat the infection, mainly to control the symptoms and accelerate clearance. · Acyclovir to treat the first and later episodes of genital herpes. This may be topical (at the site of infection), or given orally · Famciclovir to treat later episodes of genital herpes and help prevent future outbreaks. · Valacyclovir to treat later episodes of genital herpes. Response to the treatment is good when it is started early, during the small blister stage, that is, before the rupture of the blister. The blisters heal faster and the symptoms are reduced. A person who is having a genital herpes infection can follow these simple steps to hasten the healing process and avoid spreading the infection to other areas on the body or to other people: · Keep the infected area clean and dry to prevent other infections from developing. · Try to avoid touching the sores. · Saline wash should be given twice a day. · Care should be taken to wash ones hands after contact with the sores. · Avoid sexual contact from the time a person first feels any symptoms until the scabs have fallen off and new skin has formed.

What happens when a pregnant women has a herpes infection?

When a pregnant woman is infected for the first time by genital herpes, she can pass the virus to her unborn child during delivery. The child could also be born premature. Half of the babies infected with herpes either die or suffer from nerve damage. Herpes infection in the newborn infant can cause serious problems that could affect the brain, the skin, or the eyes. If such babies are treated immediately with acyclovir, their chances of being healthy are increased. If a pregnant woman is having an outbreak with herpes lesions in or around the birth canal and goes into labor, a doctor may choose to deliver the baby by cesarean section, to protect the baby from being infected.

How can a person with herpes, avoid infecting another?

If a person has early signs of a herpes outbreak or visible sores, sexual intercourse (even oral sex) should be avoided totally, until the sores have healed completely and the signs of infection have disappeared completely. Using condoms during sexual intercourse may offer protection from the virus.

Tracing of the contacts who could have been infected, and treatment of the partners, forms an important part of preventing the spread of the disease.