In most cases genital herpes is a chronic sexually transmitted infection caused by the Herpes simplex virus 2 (HSV-2). However, more than one third of the infections are nowadays caused by HSV-1. After infection the virus always remains latent in the body.
The virus is particularly contagious in the symptomatic phase; however, asymptomatic virus shedding is also known to occur. Partners who are unaware of carrying the virus transmit the virus in about half of the cases.
The risk of infection is greater from man to woman than from woman to man.
Symptoms
The clinical picture of genital herpes is often typical and easy to diagnose.
Problems arise when the manifestations are atypical, such as intermittent itching in the genital area, fissures and erythema. In order to provide adequate care and prevent the patient from spreading the disease it is essential to recognize these as symptoms of herpes.
Primary herpes infection may also be asymptomatic.
Virus secretion continues for about 2 weeks.
During pregnancy the risk of foetal infection is 50% in primary herpes, but less than 5% in recurrent herpes.
Recurrent herpes
Lesions are unilateral.
Lesions and symptoms are usually limited to the genitals (picture 2); in females to the external genitals, and less frequently the cervix. Herpes may also occur in the urethra.
General symptoms are rare.
The frequency of recurrences varies individually.
The infection may recur after physical or mental stress, in females frequently during menstrual period.
The sample is taken from the lesion with a cotton swab by rubbing.
Antibody tests detect HSV-1 and HSV-2 seropositivity, i.e. carrier status, but not the location of the infection.
Nucleic acid detection test is especially well applicable for the diagnosis of neonatal herpes from the spinal fluid.
Treatment
In primary herpes oral medication shortens viral shedding, accelerates healing and reduces pain. Mere clinical suspicion is a cause for starting medication: acyclovir 200 mg × 5 or 400 mg × 3 Antiviral Treatment for the First Episode of Genital Herpes, valaciclovir 500 mg × 2 or famciclovir 250 mg × 3; treatment duration for all three drugs is 5-10 days. Indications for intravenous administration are
Prophylactic medication can reduce viral secretion considerably. Transmission is, however, still possible.
At present there is no drug for eradication of the virus from neural sensory ganglions.
To identify early symptoms and thus reduce the risk of transmission, the patient needs information on the natural course of the infection and infectivity.
References
Patel R, Kennedy OJ, Clarke E, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS 2017;28(14):1366-1379. [PubMed]
Kortekangas-Savolainen O, Orhanen E, Puodinketo T et al. Epidemiology of genital herpes simplex virus type 1 and 2 infections in southwestern Finland during a 10-year period (2003-2012). Sex Transm Dis 2014;41(4):268-71. [PubMed]