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Genital Herpes

Online Consultation

Iqra Mazhar

Overview

Genital herpes is a sexually transmitted infection (STI) that causes herpetic sores. Herpetic sores are painful blisters filled with fluid, which can break open and ooze out the liquid.

Genital herpes is caused by herpes simplex virus (HSV). The virus spreads through sexual transmission. After the initial infection, it lies dormant in the body and can reactivate multiple times per year.

The STI can lead to pain, itching, and genital sores. However, it is possible you may not experience any signs and symptoms of genital herpes. Even if you don&rsquo;t have any visible sores, you may still be contagious.

Genital herpes does not have a cure, but the right medications can ease the symptoms and reduce the risk of transmission. If either of the spouses has tested positive in the past, they should use condoms to prevent the spread of genital herpes infection. 
&nbsp;

Herpes is categorized into two types:

<ul>
	<li>Herpes Type 1 (HSV-1 or oral herpes)</li>
	<li>Herpes Type 2 (HSV-2 or genital herpes)</li>
</ul>

Herpes type 1 causes sores in the mouth and lips. It can also cause fever blisters or cold sores occasionally. Although HSV-1 can cause genital herpes, the causative virus of most cases of genital herpes is HSV-2. Infected individuals may get sores around their genitals and rectum in HSV-2. The sores are mostly found below the waist, but they can occur in other locations as well.

Herpes simplex type 1 is transmitted through sores and oral secretions, which spread through skin-to-skin contact, for example kissing, and sharing toothbrushes, objects, and utensils. Generally, a person can get herpes type 2 infection during sexual intercourse with someone who has the viral infection. Moreover, it is necessary to be aware that HSV-1 and HSV-2 can spread even in the absence of sores. 
Women who are pregnant and have genital herpes should consult their healthcare provider because it can pass during childbirth.

&nbsp;

Furthermore, people who have the herpes virus in dormant states can experience re-activation due to the following:

<ul>
	<li>Mild to serious illness</li>
	<li>Emotional or physical stress</li>
	<li>Fatigue</li>
	<li>Immunosuppression due to <a href="https://www.merisehat.pk/disease/aids" target="_blank">AIDS</a>, chemotherapy, steroids, or other medications</li>
	<li>Trauma and sexual activities</li>
	<li>Menstruation in women 
	&nbsp;</li>
</ul>

<h5>HSV 1 (Oral Herpes)</h5>

The blisters mostly appear on the lips or around the mouth. Blisters are also seen on the face, but rarely. Although the sores commonly appear around these places, they can be seen anywhere on the skin. 
&nbsp;

<h5>HSV-2 (Genital Herpes)</h5>

Sores are usually seen on the vagina, penis, buttocks, and anus. Sores can appear inside the vagina in women, and just like oral herpes, they can appear anywhere.&nbsp;The possibility of fever, swollen lymph nodes of the neck or groin, and muscle aches are high. People with genital herpes have problems urinating and a burning sensation while passing urine.

Herpes keratitis can also be triggered. This happens when the herpes simplex virus spreads to both eyes and the patients usually have pain, sensitivity to light, gritty eyes, and discharge. Moreover, if it is not treated immediately, it can cause scarring of the eyes and vision loss.

The symptoms of herpes simplex virus last for the following period:

<ul>
	<li>Oral Herpes: 2 to 3 weeks</li>
	<li>Genital Herpes: 2 to 6 weeks (first outbreak)</li>
</ul>

The development of the outbreak is around the genitals or mouth, but it can appear anywhere on the skin. 
&nbsp;

Signs And Symptoms

Oral herpes infection does not have any symptoms, but it can include open sores or painful blisters inside or around the mouth. Tingling, burning, or itching is common in infected persons before the sores appear. The frequency of the symptoms varies from person to person, and they can recur periodically.

Genital herpes is often asymptomatic. However, when symptoms do occur, they are characterized by one or more ulcers or blisters on the anus and genitals. If the infection is new, the symptoms include swollen lymph nodes, body aches, and fever.&nbsp;

The recurrence of HSV-1 is rare, but the recurrence of the symptoms of HSV-2 is common. However, symptoms of recurrence are usually less severe compared to the first time and they decrease with time.

A lot of people with the HSV are unaware that they have it, because it is asymptomatic, or the symptoms are very mild.

The symptoms usually start after two to twelve days of virus exposure and may include:

&nbsp;

<ul>
	<li>Itching Or Pain</li>
</ul>

Pain and tenderness in the genital area are experienced by most patients till the infection clears.

&nbsp;

<ul>
	<li>White Blisters Or Small Red Bumps</li>
</ul>

The bumps and blisters appear after a few days or a few weeks post-infection.

&nbsp;

<ul>
	<li>Ulcers</li>
</ul>

Herpetic ulcers or blisters tend to rupture, ooze, or bleed, which can make urination painful.

&nbsp;

<ul>
	<li>Scabs</li>
</ul>

The skin crusts over and forms scabs after the ulcers heal.

In the initial stages, the symptoms and signs are swollen lymph nodes in the groin, muscle aches, headaches, and fever.

&nbsp;

<h5>Symptoms Of Genital Herpes Based On The Location</h5>

The sores appear at the site of infection and can spread by touching, rubbing, or scratching another part of the body. It can also spread to the eyes.

Men and women develop sores on the following parts:

<ul>
	<li>Urethra</li>
	<li>Anus</li>
	<li>Buttocks</li>
	<li>Thighs</li>
	<li>Mouth</li>
</ul>

Women can develop sores on the following parts:

<ul>
	<li>Cervix</li>
	<li>External genitals</li>
	<li>Vaginal area</li>
</ul>

Men can develop sores on the following parts:

<ul>
	<li>Scrotum</li>
	<li>Penis&nbsp; 
	&nbsp;</li>
</ul>

<h5>Recurrence Of Signs And Symptoms</h5>

The symptoms of genital herpes are different for every person. The symptoms recur on and off for many years. Some people can get it numerous times, and many get it less frequently.

When the symptoms recur, the affected person may feel burning, tingling, and itching in the area of infection. They may also feel pain in the legs, buttocks, and lower back. But the pain in recurrence is generally less painful than the first infection 
&nbsp;

Causes

Two types of herpes simplex virus can cause genital herpes:

<h5>&nbsp;</h5>

<h5>HSV 1</h5>

HSV 1 type mostly causes cold sores around the mouth. It also causes fever blisters and often spreads via skin-to-skin contact. It can also spread during oral sex. Moreover, it recurs less frequently compared to HSV-2 infection.

Examples of direct contact include the following: 
&nbsp;

<ul>
	<li>Oral sex</li>
	<li>Kissing</li>
	<li>Other skin-to-skin contact</li>
</ul>

If a partner touches the cold sores and touches their own genitals or face right after, they can contract the virus. Moreover, children also contract the virus after being touched or kissed by an adult with cold sores.

The virus can also be transmitted by sharing lip balms or razors. Utensils and drinkware can also transmit it, but all these factors are very rare. It has been estimated that the virus only lives for some hours outside the body<a href="#accordion">[1]</a>.

If someone who has cold sores drinks from a certain glass and that glass is immediately used by someone else, then that other person can contract herpes. However, the chances of spread via this route are usually very low, and mostly, the virus is transmitted through contact with sores or infection sites when the virus is shedding.

&nbsp;

<h5>HSV 2</h5>

HSV 2 is commonly known to cause genital herpes. It spreads via sexual or skin-to-skin contact. HSV is extremely common and contagious despite the absence of open sores.

Moreover, the virus dies very quickly when it is outside the body, making it nearly impossible to spread via contact with toilets or objects used by infected individuals.

 
Direct contact includes the following:&nbsp;

<ul>
	<li>Oral sex</li>
	<li>Kissing</li>
	<li>Sharing sex toys during sexual intercourse</li>
	<li>Penetrative sex without condoms</li>
	<li>Skin-to-skin contact at the infection site</li>
</ul>

Although HSV-1 is known as oral herpes and HSV-2 is called genital herpes, it either causes oral or genital symptoms.

&nbsp;

Screening for the identification of the virus and appropriate counseling can prevent the transmission. Furthermore, it can also reduce the death rates due to symptomatic recurrence. Antiviral suppressants or episodic antivirals are prescribed for the prevention of shedding and episodes.&nbsp;

Serologic screening identifies seronegative pregnant women. It is followed by appropriate counseling for the reduction of HSV infection in newborns. Moreover, women who acquire HSV during late pregnancy and those who are seronegative during delivery are at the highest risk of vertical transmission.

FDA has approved specific serological tests that rely on glycoprotein G for distinguishing between the antibodies of HSV-1 and HSV-2. Although, it takes six weeks to three months for the antibody to respond after exposure<a href="#accordion">[2]</a>.

HSV-2 rarely causes an infection anywhere, but the anogenital region, so the antibodies in serum can be interpreted for the indication of genital herpes. HSV Western blot is considered the gold standard for diagnosing herpes via the serological test.&nbsp;

Genital HSV-1 infection can&rsquo;t be diagnosed with serologic tests. Viral culture and PCR-based testing are preferred for people with genital herpes. Furthermore, these tests are not recommended in people who don&#39;t have any genital lesions, or if they experience intermittent viral shedding.

&nbsp;

Diagnosis

Healthcare providers diagnose the herpes virus through visual examination of the sores. Testing is not always necessary for diagnosing herpes, but it is required for the confirmation of the diagnosis.

HSV can be diagnosed before the outbreak by a blood test. However, if the person hasn&rsquo;t been exposed and no symptoms are present either, screening for HSV-1 and HSV-2 is not necessary.

&nbsp;

<h5>Tests To Diagnose Genital Herpes</h5>

Genital herpes is one of the most common STDs, and although it is transmitted through sexual contact, people don&rsquo;t always know about its presence. In most cases, genital herpes does not have any symptoms, so a person can be unknowingly contagious. Moreover, the symptoms can be mistaken for something else, too. So, without testing and treatment, you can risk infecting your partner.

People may develop sores on their genitals, anus, buttocks, and thighs. If you feel you have any of these, contact your healthcare provider who will perform tests to see if you have HSV. 
&nbsp;

<h5>Genital Herpes Tests&nbsp;</h5>

The tests that diagnose and screen genital herpes include:

<ul>
	<li>PCR Test</li>
</ul>

If a person does not have symptoms, a PCR test can tell if you have genital herpes. A sample is taken from the cells or fluid of the genital sore/urinary tract, and it is tested for the pieces of the virus&rsquo;s DNA. This test is used very commonly and diagnoses genital herpes accurately.

<ul>
	<li>Cell Structure</li>
</ul>

Healthcare providers can take a sample of the cells from a sore and look for the virus under a microscope.

If a person has been infected recently, or if the sores are in their healing stage, cell culture or PCR may give a false negative result. False-negative means the person has the condition, but the test didn&rsquo;t detect it. Moreover, if a person tests positive, but the chances of getting the virus are low, further testing is needed.

&nbsp;

<h5>Other Tests For Genital Herpes</h5>

Antibodies can be detected through a blood test. Antibodies are proteins that the immune system produces as a response to an infection. A solution that consists of HSV antibodies and fluorescent dye is added to the cell sample in direct fluorescent testing. If the virus is present, the antibodies glow and stick. It can be seen under a microscope. However, this does not tell when a person has been infected and it can take weeks for the formation of antibodies.

&nbsp;

Treatment

Herpes simplex virus cannot be cured, but treatment can reduce the symptoms.

<h5>&nbsp;</h5>

<h5>Medications</h5>

The healing process can be sped up with antiviral drugs. In addition, medications can also reduce pain. Those affected should start taking medication at the first sign of the virus outbreak. For example, tingling, burning, itching, and other symptoms. Medications can help reduce these symptoms. Moreover, if there has been an infection, healthcare providers prescribe medications for the prevention of future infections.

<h5>Home Care</h5>

Mild cleansers and showering with warm water can help. Moreover, keep the site of the infection clean and dry, and wear loose clothes to stay comfortable.

&nbsp;

The complications associated with genital herpes are:

&nbsp;

Other STIs

When a person has genital sores, their risk of getting or transmitting other STIs becomes higher, which also includes <a href="https://www.merisehat.pk/disease/aids" target="_blank">AIDS</a>.

Neonatal Infection

Babies who are born to HSV-infected mothers are exposed to the virus during birth. It can cause brain damage, blindness, and death.

Bladder Problems

Sores that are associated with genital herpes can cause inflammation in the urethra in some cases. Insertion of a catheter may be needed because swelling can close the urethra.

<a href="https://www.merisehat.pk/disease/bacterial-meningitis" target="_blank">Meningitis</a>

It is very rare, but HSV can cause inflammation of the membranes and CSF surrounding the brain and spinal cord.

Proctitis

Genital herpes can cause proctitis, which is inflammation of the rectal lining. It is more common in gay men. 
&nbsp;

HSV can be contracted by anyone, and their age does not matter. If anyone is exposed to HSV, they will contract the virus.

HSV is very common, but since the symptoms don&rsquo;t always appear, people live with the virus without realizing that they have contracted it.

The chances of contracting HSV are higher in the following cases<a href="#accordion">[5]</a>: 
&nbsp;

<ul>
	<li>Having a sexual partner with HSV</li>
	<li>Immunocompromised</li>
	<li>Unprotected Sex - The chances of getting genital herpes simplex virus are higher if condoms are not used during sexual intercourse. However, people need to bear in mind that condoms and other methods of protection do not cover the site of infection&nbsp;because sores can be on the inner thighs and buttocks.</li>
	<li>Transmission During Childbirth -&nbsp;Research conducted in 2021 claimed that 1 in 1000 babies are born with neonatal HSV<a href="#accordion">[3]</a>. So, if a mother has contracted HSV before pregnancy and the infection is recurrent, they are unlikely to transmit the virus to their baby during delivery. However, if the virus was transmitted during late pregnancy, the risk is increased. The virus is serious and can cause complications, including premature delivery. It is necessary to let a healthcare provider know if anyone assumes they may have HSV. 
	&nbsp;</li>
</ul>

The prevention measures for genital herpes are the same as other STIs. Those infected should limit sexual contact till they are infection-free.

<ul>
	<li>Using condoms during sexual contact can prevent the transmission of the infection.</li>
	<li>If either of the partners has an outbreak, sexual contact should be avoided. 
	&nbsp;</li>
</ul>

<h5>Preventive Measures For Pregnant Women</h5>

Tell your healthcare provider if you are pregnant and have genital herpes. Get tested for it if you are not sure.

Your healthcare provider will ask you to take antivirals for herpes during late pregnancy to prevent an outbreak and transmission during delivery. Moreover, if you have an outbreak during labor, the gynecologist will most likely recommend a C-section to prevent transmission of the virus to the baby. 
&nbsp;

A current study has identified a new approach to attacking herpesvirus. The study demonstrated that when two metal ion-dependent enzymes of HSV are targeted with the compounds AK-157 and AK-166 (two 8 hydroxyquinoline), the replication of the virus can be inhibited. This finding has provided new opportunities for the development of agents against HSV<a href="#accordion">[4]</a>.

People are aware of what the herpes simplex virus is, but what they don&rsquo;t know is that it is a family of nine different viruses. It also includes CMV. They can cause problems in patients receiving&nbsp;chemotherapy or immunocompromised patients. Due to this, better therapeutic agents are needed for vulnerable patients. Moreover, most of the currently available agents are ineffective in treating all the viruses, with dose limitations and tremendous side effects.

&nbsp;

Researchers are working on making a single drug that will inhibit all nine of the herpes viruses. The strategy is based on targeting two viral enzymes that are dependent on metal ions. The study tested the compounds to inhibit those two specific metal-ion-dependent enzymes and HSV replication.&nbsp;

The compounds panel that was tested comprised of anti-influenza agent baloxavir, HIV integrase inhibitors, three natural products that previously exhibited anti-HSV activity, and two 8-hydroxyquinoline (AK-157 and AK-166).&nbsp;The HIV integrase inhibitors inhibited the replication of HSV, but the researchers found that the overall activity was weak for anti-HSV-1. Although, the two 8-hydroxyquinoline showed strong antiviral activity against HSV and CMV. So, it was concluded that it can inhibit the other 2 metal ion-dependent enzymes. This makes it possible to develop agents that are dual targets against herpes virus.

&nbsp;

Key Points

<ul>
	<li>HSV has two types: HSV-1 and HSV-2.</li>
	<li>HSV-1 is mostly transmitted through oral contact, which causes oral herpes. However, it can also lead to genital herpes.</li>
	<li>HSV-2 is sexually transmitted, and it causes genital herpes.</li>
	<li>3.7 billion people under 50 years have HSV-1 infection across the world, whereas 491 million people between the age of 15 and 49 have HSV-2 infection.</li>
	<li>HSV infection is mostly asymptomatic, but some people have painful ulcers and blisters, which can recur once a year.</li>
	<li>The virus increases the risk of transmission of other STIs.</li>
</ul>

&nbsp;

[1] Kramer, A., Schwebke, I. and Kampf, G., 2006. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC infectious diseases, 6(1), pp.1-8.

[2] Feltner, C., Grodensky, C., Ebel, C., Middleton, J.C., Harris, R.P., Ashok, M. and Jonas, D.E., 2017. Serological Screening for Genital Herpes: An Evidence Review for the US Preventive Services Task Force.

[3] Saleh, D., Yarrarapu, S.N.S. and Sharma, S., 2021. Herpes simplex type 1. In StatPearls [Internet]. StatPearls Publishing.

[4] DiScipio, K.A., Weerasooriya, S., Szczepaniak, R., Hazeen, A., Wright, L.R., Wright, D.L. and Weller, S.K., 2022. Two-Metal Ion-Dependent Enzymes as Potential Antiviral Targets in Human Herpesviruses. Mbio, 13(1), pp.e03226-21.

[5] James, C., Harfouche, M., Welton, N.J., Turner, K.M., Abu-Raddad, L.J., Gottlieb, S.L. and Looker, K.J., 2020. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 98(5), p.315.