Genital herpes infection is a sexually transmitted disease. It is a viral infection caused by the herpes simplex virus (HSV), primarily by HSV-2 and to a lesser extent by HSV-1.
Herpes simplex virus type 1 (HSV-1) usually causes oral herpes (cold sores), while type 2 (HSV-2) is mainly responsible for genital herpes.
However, HSV-1 can also cause genital herpes through oral-genital contact (oral sex).
It is the most common cause of sexually transmitted ulcers worldwide.
Finally, infection with HSV-2 increases the risk of HIV infection and transmission by 2–3 times, even after the healing of HSV-2-related ulcers and erosions.
It can affect the skin and mucous membranes and occurs in both sexes. Symptoms tend to appear more frequently in women. Genital herpes can present in various clinical forms and with differing severity, or may even cause no symptoms at all (asymptomatic infection).
The infection is lifelong, with intermittent clinical and subclinical reactivation of the virus and shedding from mucosal or skin surfaces. Some individuals carry the virus without showing any visible clinical lesions.
However, the typical clinical picture of the primary infection appears a few days (usually 3–7 days) after the initial exposure to the virus. Once the virus enters the body, it begins to replicate in the cells of the epidermis or mucous membranes, causing temporary cell destruction. This manifests as erythematous papules and vesicles filled with serous or seropurulent fluid, redness, and swelling of the affected area.
Over the next few days, the roofs of the vesicles rupture, leaving erosions and ulcers that heal slowly, with the possibility of new lesions appearing for up to 2–3 weeks.
Some systemic symptoms caused by herpes infection include:
Fever, chills, fatigue, myalgia, lower back pain
Lymphadenopathy in the lymph nodes draining the affected area
Pain, discomfort, burning or tingling sensation, itching
In women, dysuria (painful urination), vaginal pain, and vaginal discharge are often observed
Subsequently, through peripheral sensory nerves, the virus begins its journey within the body, ultimately reaching the sensory ganglia, where it remains for life in a latent state. Upon reactivation, it migrates in reverse from the sensory ganglion to the surface of the mucosa or skin within the corresponding dermatome, where it replicates and is shed through secretions or cellular apoptosis.
Triggers for reactivation may include infection, trauma, stress, UV radiation exposure, menstruation, immunosuppression of any cause, or it may occur spontaneously without any known predisposing factor. Most recurrences do not result in a clinical episode, as they are contained by cellular immunity.
In women, the lesions most commonly occur inside the vagina, as well as externally on the labia minora and majora. In men, they are located along the penis and in the scrotum area. Lesions can be seen in both sexes on the thighs, buttocks, and around the anus.
Its diagnosis is based mainly on a detailed medical history, clinical examination and detection of the characteristic lesions of the disease, which is accompanied by special laboratory testing.
To determine which virus has caused the skin lesions on the genitals, a special blood test is performed, which includes molecular and immunological testing (herpes antibodies and herpesvirus molecular testing).
The treatment of the primary infection and subsequent episodes includes antiviral agents and analgesic therapy to relieve the symptoms of the disease. However, unfortunately, these treatments cannot eradicate the virus, which remains in the body permanently. In cases of frequent recurrences, suppressive therapy may be administered. Modern pharmacological treatment, when administered properly, reduces the duration of each episode, prevents recurrences, and limits the transmission of genital herpes. Finally, consistent use of condoms—even between recurrences—reduces the risk of transmission.
A first episode (i.e. a new infection) of genital herpes during pregnancy can have serious effects on the fetus if left untreated. However, a recurrence of old genital herpes usually does not cause problems for the fetus. The mother will normally receive treatment as if she were not pregnant.
- Avoid touching the sore with bare hands, as the virus can be transferred to another location—for example, from the mouth to the fingers, nose, or eyes.
- Regular and thorough hand washing is recommended.
- Sexual intercourse is strictly prohibited when visible lesions are present, and in any case, the use of condoms is strongly advised.
- To prevent herpes recurrences during the summer, the use of sunscreen with a high protection factor is recommended.
No, the virus does not survive long outside the body; therefore, genital herpes is transmitted only through sexual contact, the exchange of bodily fluids, and direct skin-to-skin contact with the lesion.