Genital herpes: causes, symptoms, diagnosis and treatment

Genital herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). Although there is no definitive cure for this viral infection, there are treatment options that can help reduce symptoms and prevent the spread of the virus to others

Genital herpes: what are the symptoms?

In 80% of cases, genital herpes runs asymptomatic.

When symptomatic, after an incubation period of about 4-7 days, it presents mainly with pain and itching in the genital area.

Macroscopically, the infection presents with the appearance of one or more vesicles on the external genitalia (penis and scrotum in the male, vulva and vagina in the female) that may also involve the perianal area, accompanied by

  • underlying inflammation
  • pain
  • itching
  • formation of ulcers

More rarely it may be accompanied by

  • fever
  • general malaise
  • muscle pain
  • swollen inguinal lymph nodes
  • tingling of the area

These blisters may disappear and reappear after hours or days and, if left untreated, may persist for three or four weeks.

When they resolve, the virus is not eliminated but remains within the nerve ganglia corresponding to the affected areas, in a latent phase, without causing symptoms or lesions but replicating imperceptibly.

The reactivation of the virus, often caused by a weakened immune system due to physical or psychological stress or chronic illness, can lead to the reoccurrence of lesions in the same area where the primary infection occurred or in other areas of the external genitalia, in the perianal region and on the surrounding skin.

In these cases, timely treatment can reduce the extent and duration of the lesions.

What causes genital herpes?

Genital herpes is mainly transmitted during sexual intercourse of all types (vaginal, oral and anal) not protected by a condom, through body fluids or direct contact of the vesicles with the genitals.

The virus is highly contagious during the active phase of infection, when vesicles are present, but can also be transmitted during the latent phase, although with lower probability.

Spread may occur through direct contact between genitals or skin or, less commonly, through indirect hand contact.

During pregnancy, then, the virus can be transmitted from the mother to the foetus during delivery, with the risk of causing serious complications to the eyes, mucous membranes (oral and nasal), face and impairing the central nervous system and vision.

Diagnosis of genital herpes, what tests should be done?

The diagnosis of genital herpes is mainly based on the observation of typical blisters on the surrounding skin or genital mucous membranes.

To confirm the infection, one can look for HSV-1 and 2 antibodies in the blood.

The presence of immunoglobulin M (IgM) indicates an active infection contracted for the first time, whereas the presence of immunoglobulin G (IgG) alone indicates a past infection.

In addition, the PCR technique can be used to search for viral DNA in swab material taken from lesions, which is the gold standard for diagnostic certainty.

How is genital herpes treated?

Genital herpes can remain in a latent form in nerve cells for many years, which makes it extremely difficult to completely eliminate the virus from the body.

During the active phase of the infection, antiviral drugs (acyclovir, valacyclovir or famciclovir) can be used to effectively treat the infection, causing symptoms and lesions to disappear and interfering with virus replication.

Adequate treatment of the primary infection is important to prevent the spread of the virus in nervous tissue and to reduce the risk of recurrences associated with the presence of the virus in latent form.

In cases of immunodeficiency caused by viral diseases such as AIDS or other severe and persistent diseases, treatment of these conditions is essential to limit the risk of genital herpes reactivation.

Genital herpes: how to prevent infection

Effective prevention of genital herpes during sexual intercourse is possible by using a condom, although in some situations lesions may be found in areas not covered by a condom, such as the scrotum or perianal skin.

It is important to recognise any lesions on the genitals early on in order to identify their nature, initiate appropriate treatment and prevent transmission of the infection to others.

When one is infected with genital herpes, it is then important to refrain from having intercourse until the lesions have healed.

If the infection occurs during pregnancy, treatment with Acyclovir is possible.

If it occurs for the first time in the third trimester, delivery by caesarean section is recommended to avoid vertical transmission to the newborn.

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