Genital herpes is a sexually transmitted disease of the genital area, the skin around the rectum or adjacent areas, caused by the herpes simplex virus.
There are two types of herpes simplex virus, HSV-1 and HSV-2. Generally, HSV-2 is transmitted sexually, whereas HSV-1 usually infects the mouth.
The two types of herpes simplex virus can infect the genitalia, the skin around the rectum or the hands (especially the nail beds) and can be transmitted to other parts of the body (eg, to the surface of the eyes).
In general, herpes lesions are not infected by bacteria, but some herpes sufferers also have other sexually transmitted microorganisms (eg, syphilis or chancroid) in the same ulcers.
Symptoms of the initial (primary) episode begin 4 to 7 days after infection.
Usually, the initial symptoms are pruritus, tingling and discomfort.
Next, a small red spot appears, followed by a group of small painful vesicles.
The blisters rupture and fuse, forming circular ulcers. Ulcers, which are commonly painful, form crusts after a few days.
Urination and gait can be difficult. Ulcers heal in about 10 days, but may leave scars.
In general, the lymph nodes of the inguinal region show a small increase in volume and are painful
. The first episode is more painful, prolonged, and widespread than the next, and the individual may experience fever and a general sense of malaise.
In men, vesicles and ulcers can occur anywhere on the penis, including the foreskin when the individual is not circumcised.
In women, the blisters and ulcers may occur on the vulva, inside or around the vagina and cervix.
Women who maintain anal intercourse may have vesicles and ulcers around the anus or rectum.
In individuals with compromised immune systems, for example those infected with the human immunodeficiency virus (HIV), herpes ulcers can be severe, spreading to other areas of the body, persisting for weeks or longer, but rarely resist treatment with acyclovir.
Symptoms tend to recur in the same or adjacent areas, as the virus persists in nearby pelvic nerves, reactivating to reinfect the skin.
HSV-2 is more capable of reactivating in the pelvic nerves. HSV-1 reacts more effectively in the facial nerves, causing cold sores.
Nevertheless, any of these viruses can cause disease in any of these areas.
Previous infection by either virus provides partial immunity against the other, making the symptoms of the second viral infection less serious.
Genital Herpes Complications
Approximately 3 to 12 days after the first occurrence of blisters in the genital area, the herpes virus can spread to other parts of the body.
However, the rare complications are serious.
Membranes lining the brain (meninges) can be infected, causing vomiting, headache and stiff neck.
The spinal cord can also be infected, causing weakness of the lower limbs.
Nerves in the pelvic area may also be affected, causing temporary pain, constipation, inability to urinate and, in men, impotence.
Although rare, the virus can spread through the bloodstream to the skin, joints, liver or lungs, especially in neonates or in individuals with compromised immune systems.
The most common complication of genital herpes is the repeated return of the blisters and ulcers, which are usually limited to one side of the body, the episodes being lighter than the initial one.
Before each episode, the individual may feel a general discomfort, itching, tingling or pain in the affected area.
The risk of recurrence in the genital area is greater with HSV-2 than with HSV-1.
However, the frequency of recurrences varies greatly.
In some individuals, episodes occur many times over many years.
There may be recurrence of ulcers beyond the genital area, reaching the buttocks, inguinal regions and thighs.
The doctor suspects herpes based on the patient's symptoms.
Diagnosis can be established rapidly by microscopic examination of ulcer specimens.
To confirm the diagnosis, swabs (secretion sample) of an ulcer are sent to special laboratories for culture.
Results may be available in as little as 48 hours.
Blood tests may reveal evidence of past infection or suggest a recent infection when antibody levels are increasing.
Genital herpes has no cure, but treatment can reduce the duration of the episode.
The number of episodes can be reduced with continued treatment with low doses of antiviral drugs.
Treatment is most effective when started early, usually within 2 days of onset of symptoms.
Aciclovir or related antiviral drugs may be administered orally or may be applied as a cream directly into the lesions. These drugs reduce the elimination of live virus from wounds, thus reducing the risk of transmission.
The drug may also decrease the severity of symptoms during the initial episode.
However, even early treatment of the first episode does not prevent recurrences.
Patients with a history of herpes can be infectious to their sexual partners even when they do not realize they are having a new episode.