Genital Herpes


Written by : Dr.M.D.Mazumdar, MD

Genital herpes is a sexually transmitted disease caused by the Herpes Simplex Virus. There are two types of the virus - Herpes Simplex Virus type 2 (HSV2) and Herpes Simplex Virus type 1 (HSV1).

Both these two types can cause genital herpes. But in almost 90% of cases, genital herpes is caused by HSV2.

The HSV1 virus commonly causes infections in the mouth (oral herpes) with symptoms of painful sores on the lips, gums, tongue, roof of the mouth, and inside the cheeks. It also can cause symptoms such as fever and muscle aches.

Spread of Genital Herpes

The HSV2 virus spreads during sexual contact, either during vaginal, oral or anal sex. It can also spread through close skin to skin contact as in kissing or cuddling as the virus can also be shed through the skin. It is estimated that the incidence of Herpes infection in the USA is about 1 out of every 5 adults.

Signs and Symptoms of Genital Herpes

  • The first symptom occurs within 2 weeks of exposure to the virus, commonly within 3 - 7 days. The area on the skin or genital organs through which the virus enters, may tingle or may produce a mild discomfort which are ignored or not noticed by the person.

  • Small, shallow, multiple reddish blisters appear on the skin within 2 weeks on and around the vagina, cervix, labia and rectum. They may also be seen around the urethral opening.

  • The blisters break down into small shallow sores or ulcers in a day or two. These ulcers are extremely painful and sometimes itchy.

  • The ulcers heal by forming crusts that peel off later. There may be no scars left behind. Sometimes small pale colored areas are seen which merges with the surrounding skin.

  • Other symptoms that can accompany the genital symptoms are fever, headache, general body ache, muscle aches, burning urination, vaginal discharge and sometimes swollen lymph nodes in the groin.

  • There may be several recurrences within the year but usually these are milder than the first attack. The number of attacks decrease in time.

  • The virus remains quietly in the nerve ganglia causing recurrences from time to time. They can never be completely eradicated.

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Tests and Diagnosis

  • Diagnosis is not difficult when the patient is examined during an outbreak of the disease. The small, shallow, painful ulcers associated with a history of sexual exposure can point to genital herpes.

  • Smears taken from the ulcers, the blister fluid, or the vagina, rectum or urethra during an active phase of the disease should be cultured within 48 hours for the virus to show up under the microscope. The culture results are usually available within a week.

    But the main disadvantage of culture tests is the high rate of false negative tests, especially after 48 hours of the first appearance of teh blisters. Viral cutlture is even less accurate in cases of recurrent outbreaks.

    Swabs from the symptomatic area can be tested for HSV DNA (PCR tests) - these are more accurate and show less false negatives.

  • When the disease is in a quiet phase, diagnosis is by blood tests. The blood tests can show antibodies to the virus - IgM or/and IgG. IgM levels usually rise in the initial stages of the disease but can also rise in recurrences. It is less accurate since it cannot differentiate between HSV1 and HSV2. It also cross reacts with other viral strains like varicella zoster virus (which causes chicken pox) and cytomegalovirus (which causes mononucleosis).

    IgG is more accurate and can differentiate beetween HSV1 and HSV2 (these are Type Specific tests). It is most accurate when done between 12-16 weeks of the infection.

    The blood tests cannot reveal whether the infection is in the mouth or the genitals but it is generally assumed that if the patient is infected with HSV2, then he or she is suffering from genital herpes.

Treatment

There is no permanent cure for genital herpes. The virus tends to remain in the nerve ganglia for life, causing recurrence of symptoms like blisters and sores from time to time.

Some medicines can however prevent outbreaks and decrease the severity of the infection when outbreaks do occur. Antivurus medicines like Acyclovir (available as Zovirax), Famciclovir (available as Famvir), and Valacyclovir (available as Valtrex) are availbale as oral medicines. Acyclovir is also available as cream or in IV form.

These medicines can prevent or at least decrease the intensity of future outbreaks. They can also decrease the chances of passing on the virus to the sexual partners.

The medicines for genital herpes are available both as pills and as creams to apply locally on the ulcers and blisters. The patient should be advised to apply the cream at the earliest sign of recurrence.

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