Genital herpes

Introduction

  • Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV), primarily types 1 and 2 (HSV-1 and HSV-2).
  • It is a lifelong condition characterized by periodic outbreaks of painful blisters or sores in the genital area.
  • While there is no cure, effective treatments can manage symptoms, reduce the frequency of outbreaks, and lower transmission risk.

Causes of Genital Herpes

  1. HSV-1 and HSV-2
    • HSV-1: Traditionally causes oral herpes but increasingly responsible for genital infections.
    • HSV-2: Primarily causes genital infections.
  2. Transmission
    • Direct skin-to-skin contact during vaginal, anal, or oral sex.
    • Can occur even when the infected person shows no symptoms (asymptomatic shedding).
  3. Risk Factors
    • Multiple sexual partners.
    • Inconsistent use of condoms or barriers.
    • Weakened immune system.

Symptoms of Genital Herpes

  1. Primary Infection
    • Painful blisters or ulcers on the genitals, anus, or thighs.
    • Swollen lymph nodes, fever, and body aches.
    • Burning or itching sensation before blisters appear.
  2. Recurrent Episodes
    • Milder symptoms with fewer sores.
    • Triggers include stress, illness, menstruation, or sun exposure.
  3. Asymptomatic Cases
    • Many individuals remain unaware they are infected.

Complications of Genital Herpes

  • Neonatal Herpes: Severe infection in newborns exposed during delivery.
  • Psychological Impact: Anxiety, depression, or stigma associated with diagnosis.
  • Increased Risk of Other STIs: Herpes sores increase susceptibility to HIV.
  • Urinary Retention: In rare cases, severe outbreaks may cause temporary urinary obstruction.

Diagnosis of Genital Herpes

  1. Physical Examination
    • Identification of characteristic sores or blisters.
  2. Laboratory Tests
    • Viral Culture: Detects HSV from fluid samples of sores.
    • Polymerase Chain Reaction (PCR): Identifies HSV DNA; highly sensitive.
    • Serology Tests: Detects antibodies to HSV-1 and HSV-2.

Treatment Options for Genital Herpes

1. Antiviral Medications

MedicationBrand NameManufacturerCost Range
AcyclovirZoviraxGSK$10–$30 per pack
ValacyclovirValtrexGSK$20–$50 per pack
FamciclovirFamvirNovartis$30–$60 per pack
  • Purpose: Reduce symptoms, shorten outbreaks, and suppress viral shedding.
  • Dosing:
    • Primary Outbreak: Higher doses for 7–10 days.
    • Recurrent Outbreaks: Shorter 2–5 day courses.
    • Suppressive Therapy: Daily low doses to prevent recurrences.

2. Supportive Care

  • Pain Relief: Ibuprofen or paracetamol for discomfort.
  • Warm Baths: Helps soothe sores and reduce irritation.
  • Topical Treatments: Lidocaine gel to alleviate pain or itching.

3. Prevention of Transmission

  • Barrier Methods
    • Consistent use of condoms or dental dams reduces risk.
  • Antiviral Suppression
    • Daily antivirals lower the risk of transmitting HSV to partners.
  • Avoid Sexual Activity During Outbreaks
    • Reduces the likelihood of spreading the virus.

4. Lifestyle and Alternative Therapies

  • Stress Management: Reduces recurrence frequency (e.g., yoga, meditation).
  • Dietary Adjustments: Avoid trigger foods high in arginine (e.g., nuts, chocolate).

Monitoring Parameters

  • Frequency and severity of outbreaks.
  • Adherence to suppressive antiviral therapy.
  • Periodic blood tests for serology in new partners or pregnancy.

Patient Counseling Points

  • Reassure that genital herpes is a manageable condition with treatment.
  • Educate on safe sexual practices to reduce transmission risk.
  • Discuss potential triggers for outbreaks and strategies to avoid them.
  • Encourage open communication with partners about HSV status.

Use in Children

  • Neonatal herpes requires immediate antiviral treatment with intravenous acyclovir.

Use in Pregnancy

  • Suppressive antiviral therapy in the third trimester reduces the risk of transmission.
  • Cesarean delivery may be recommended if active lesions are present during labor.

Use in Elderly

  • Ensure dosing adjustments for renal impairment; monitor for side effects like confusion.

FAQs About Genital Herpes

Q1: What causes genital herpes?

  • Herpes simplex virus (HSV-1 or HSV-2) transmitted through skin-to-skin contact.

Q2: Can genital herpes be cured?

  • No, but antiviral medications manage symptoms and reduce transmission.

Q3: How is genital herpes diagnosed?

  • Through physical examination and laboratory tests like PCR or viral culture.

Q4: What are the symptoms of genital herpes?

  • Painful blisters or sores, fever, swollen lymph nodes, and itching.

Q5: How is genital herpes treated?

  • Antiviral medications such as acyclovir, valacyclovir, or famciclovir.

Q6: Can I transmit herpes without symptoms?

  • Yes, asymptomatic viral shedding can occur.

Q7: Are there home remedies for herpes?

  • Warm baths and pain relief can alleviate symptoms but do not replace antiviral therapy.

Q8: Is genital herpes common?

  • Yes, it is one of the most common sexually transmitted infections globally.

Q9: Can genital herpes affect fertility?

  • No, herpes does not directly impact fertility.

Q10: How can I prevent herpes transmission?

  • Use condoms, avoid sexual activity during outbreaks, and consider suppressive antiviral therapy.

Q11: Is it safe to have a baby with genital herpes?

  • Yes, with appropriate treatment and management during pregnancy.

Q12: What triggers herpes outbreaks?

  • Stress, illness, menstruation, or exposure to sunlight.

Q13: Can genital herpes cause complications?

  • Rarely, it can cause meningitis or urinary retention in severe cases.

Q14: Are cold sores and genital herpes the same?

  • They are caused by the same virus but occur in different locations.

Q15: Should I disclose my herpes status to partners?

  • Yes, open communication helps partners make informed decisions.