WHAT IS GENITAL HERPES?

Genital herpes is a sexually transmitted infection (STI) caused by the human simplex Virus (HSV). It is usually spread by having vagina, oral, or anal sex. Women are more susceptible than men. One in five women ages 14 to 49 has genital herpes.
After the first infection, the virus lies latent (inactive) in your body and can reactivate several times a year.There is no cure for herpes. But you can take medicine to prevent outbreaks (the appearance of blisters) and to lower your risk of passing genital herpes to your partner.

WHAT ARE THE SIGNS AND SYMPTOMS ?

Most people with genital herpes do not know they have it. About one third of newly infected individuals show symptoms, which can be severe. It also can be severe and long-lasting in people who have low immune function.

Within a few days of sexual contact with someone who has the herpes virus, sores (small red bumps that may turn into blisters) may show up where the virus entered your body, such as on your mouth or vagina. Some people might confuse mild sores for insect bites or something else.

After a few days, sores become crusted and then heal without scarring. Sometimes, a second set of sores appear soon after the first outbreak, and symptoms can happen again.

The first signs of the infection usually show up three to 12 days after having sexual contact with someone who has herpes. Symptoms can last from two to four weeks. There are other early symptoms of the infection :

• Pain or itching in your genital area until the infection clears.
• Small red bumps or tiny white blisters. These may appear a few days to a few weeks after infection.
• Ulcers. These may form when blisters rupture and ooze or bleed. Ulcers may make it painful to urinate.
• Scabs (The crust-like surface of a healing skin lesion).

During an initial outbreak, you may have flu-like signs and symptoms such as fever, malaise, swollen lymph nodes in your groin, headache and muscle aches.

Differences in symptom location

Sores appear where the infection entered your body. You can spread the infection by touching a sore and then rubbing or scratching another area of your body, including your eyes.

Men and women can develop sores on the:

• Buttocks and thighs
• Anus
• Mouth
• Urethra (the tube that allows urine to drain from the bladder to the outside)

Women can also develop sores in or on the:

• Vagina area
• External genitals
• Cervix

Men can also develop sores in or on the:

• Penis
• Scrotum

CAN GENITAL HERPES COME BACK?

The signs and symptoms may recur intermittently for years. Because of viral latency, the infection persists indefinitely and any decrease in immune function as well as stress, trauma, ultraviolet radiation and hormonal imbalance can trigger reactivation of the virus and recurrence of sores. During a recurrence, shortly before sores appear, you may feel:

• Burning, tingling and itching where the infection first entered your body
• Pain in your lower back, buttocks and legs

However, recurrences are generally less painful than the original outbreak, and sores generally heal more quickly.

WHAT ARE THE CAUSES?

Two types of herpes simplex virus cause genital herpes: HSV-1 and HSV-2

• HSV-1 most often causes infections of the mouth and lips, called cold sores or “fever blisters.” Symptoms are often milder than genital herpes, and recurrences are much less frequent than they are with HSV-2 infection. It can spread to the genital area during oral sex and cause genital herpes.
• HSV-2 is the most common cause of genital herpes. It is spread through vaginal, oral, or anal sex. HSV-2 can spread to the mouth during oral sex. HSV-2 is highly contagious, whether or not you have symptoms.

In rare circumstances, HSV-2 infection can be transmitted from a mother to her infant during delivery to cause neonatal herpes.

WHO IS AT RISK OF DEVELOPING GENITAL HERPES?

A risk factor is something that increases your chances of getting a health problem.

Genital herpes is more common in women than in men. The risk is highest among teens and young adults who are more likely to take risks with sex.

The biggest risk is the number of sex partners in a person’s lifetime. Other things that may raise your risk are:

• Sex with an infected person
• Having multiple sexual partners
• Not using a condom or using it the wrong way
• Prior Sexual Transmitted Infections (STIs)
• HIV infection or other health problems that make it hard for your body to fight infections.

CAN GENITAL HERPES CAUSE OTHER PROBLEMS?

Possible Complications associated with genital herpes are;

HSV-2 and HIV

They have been shown to influence each other. HSV-2 infection increases the risk of acquiring a new HIV infection by approximately three-fold. In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

Infection with HSV-2 in people living with HIV can have a more severe symptoms and more frequent recurrences. In advanced HIV disease, HSV-2 can lead to more serious, but rare, complications such as meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or disseminated infection.

Neonatal herpes

Neonatal herpes can occur when an infant is exposed to HSV (HSV-2 or HSV-1) in the genital tract during delivery. It is rare, but is a serious condition that can lead to lasting neurologic disability or death. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants. The risk for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy, in part because the levels of HSV in the genital tract are highest early in infection.

Rectal inflammation (proctitis)

Genital herpes can lead to inflammation of the lining of the rectum (anus), particularly in men who have sex with men.

Psychosocial Impact

Recurrent symptoms of genital herpes may be painful and the infection can lead to social stigma and psychological distress. These factors can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

HOW IS GENITAL HERPES DIAGNOSED?

Often, your doctor can diagnose the infection by looking at visible sores. Your doctor  may also use a cotton swab to take a fluid sample from a sore to test in a lab.

It can be hard to diagnose, especially between outbreaks. Blood tests that look for antibodies to the herpes virus can help diagnose herpes in women without symptoms or between outbreaks.

CAN GENITAL HERPES BE TREATED?

Herpes has no cure. But antiviral medicines can prevent or shorten outbreaks during the time you take the medicine. Also, daily suppressive therapy (for example, daily use of antiviral medicine) for herpes can lower your chance of spreading the infection to your partner.

HOW CAN I REDUCE MY RISK OF GETTING GENITAL HERPES?

The best ways to avoid genital herpes are

• Abstaining from sexual contact (vaginal, anal, and oral sex)
• Being in a long-term mutually monogamous relationship with a partner who has been tested and is not infected

Risk of genital herpes can by reduced by

• Using latex condoms correctly and consistently

However, condoms do not cover all areas that can be affected and thus do not fully protect against the infection. People should be reminded that they can transmit the infection even when they do not have any symptoms.

Pregnancy precautions

If you are pregnant and know you have genital herpes, tell your doctor. If you think you might have genital herpes, ask to be tested for it.

Your doctor may recommend that you start taking herpes antiviral medications late in pregnancy to try to prevent an outbreak around the time of delivery. If you’re having an outbreak when you go into labor, your doctor will probably suggest a cesarean section to reduce the risk of passing the virus to your baby.

F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.

REFERENCES

• https://www.mayoclinic.org/diseases-conditions/genital-herpes/symptoms-causes/syc-20356161
• https://www.womenshealth.gov/a-z-topics/genital-herpes
• https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
• https://www.msdmanuals.com/professional/infectious-diseases/herpesviruses/genital-herpes
• Robbins and Cotran (2015, pages 253, 357, 993). Pathologic Basis of Disease. 9th edition. Elsevier Saunders.