Genital herpes

Genital herpes is a sexually transmitted disease with an incidence of approximately one case in every 1000 people. It is caused by two viruses, herpes simplex type 1 and herpes simplex type 2. Type 1 usually causes cold sores or “cold sores” and is transmitted through oral secretions. It is responsible for 5-10% of genital herpes and can be transmitted during oral sex. The herpes simplex virus type 2 is responsible for most genital herpes and can be transmitted through oral or genital secretions or through contact with the skin. The contagion usually occurs during outbreaks by contact with areas of ulcers or blisters since the secretions produced in these lesions contain the virus. In any case, some research suggests that infections can also occur in the absence of symptoms. Genital herpes simplex virus type 2 infection is more common in women than in men and may be because infection is more likely from male to female than from female to male. The most frequently affected areas in men are:

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• Inner thighs
• Scrotum
• Penis

In women the most affected areas are:

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• Cervix
• Inner thighs
• Lips
• Vagina

Symptoms of initial herpes virus infection are both systemic and local and usually appear within two weeks of infection. Systemic symptoms are: loss of appetite, fever, malaise, general pain and muscle aches (myalgia). Local symptoms usually begin with increased skin sensitivity, a burning or stinging sensation, or itching. Shortly afterwards, skin rashes appear in the form of small, painful blisters, reddened and filled with a clear yellowish fluid. These blisters break and give way to very painful superficial ulcers, which eventually crust over and heal in 7 to 14 days. In women, pain in the groin and enlargement of the inguinal lymph nodes usually occur. In addition, there may be an increase in vaginal discharge and painful urination from contact with the ulcers. Men may also have dysuria if the lesions are close to the opening of the urethra. Once the person is infected, the virus establishes itself within the nerve cells, making it difficult for the immune system to identify and destroy external microorganisms, and therefore they are far from the reach of antibodies. There the virus can remain in a latency phase for a variable period of time. The infection can reactivate at any time and painful blisters reappear. There are several triggers for flare-ups such as fatigue, mechanical irritation, menstruation, stress, or sunburn. Most people who have been diagnosed with a herpes virus outbreak can expect to have several outbreaks a year, but these recurrences generally decrease in frequency as time passes. In most cases the diagnosis can be made by visual inspection if it is a typical outbreak and in cases of doubt a virus culture can be done. There is a stain called Tzank's stain performed on the skin lesion that can show results but is very rarely used. A blood test can be done to check the presence or absence of antibodies against herpes simplex virus types 1 and 2 and if it is a recent or old infection. Viral herpes cannot be cured, but treatment can shorten episodes and improve symptoms. Medications speed healing and symptom relief more in first attacks than in recurring flare-ups. antiviral treatment can be done in pills, recommended in the initial infection to reduce the pain and virulence of the outbreak, or in creams for local application later. In cases of significant pain, an oral anti-inflammatory treatment is also performed. In relapses, it is recommended to start topical treatment as soon as the symptoms of burning or pain start prior to the appearance of vesicles.

As has been commented, the most frequent symptoms caused by herpes virus are recurrent painful lesions, but in some cases it can be potentially more dangerous. In pregnant women there is a risk to the fetus in cases of first infection with the herpes virus during pregnancy. Before 20 weeks of gestation, the risk of miscarriage triples compared to the general population, and it can rarely cause fetal malformations, although they have been described. After 20 weeks of pregnancy the risk of prematurity also increases. If a woman has active herpes at the time of giving birth, a cesarean section is performed to avoid contagion through the birth route since it can cause a really severe neonatal herpetic infection, despite the fact that current treatments have improved the forecast. Immunosuppressed patients, whether due to congenital3 or acquired disorders or due to immunosuppressive treatments such as chemotherapy or radiotherapy, are at higher risk of having complications from the infection, among which are:

• Herpetic keratitis: eye infection by the herpes virus,
• Herpetic esophagitis: infection of the esophagus by the virus
• Herpetic hepatitis: infection of the liver by the herpes virus
• Encephalitis: infection of the central nervous system
• Transverse myelopathy: infection of the spinal cord
• Pneumonitis: infection of the lung tissue by the virus.

Of interest

To avoid contagion, direct contact with ulcerative or vesicular lesions should be avoided. The condom is also the best protection against genital herpes when you are sexually active.