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Genital Herpes

Essentials

  • Genital herpes should be kept in mind as a differential diagnostic alternative in a patient with recurrent indeterminate symptoms in the genital area.
  • Antivirals are effective in relieving the symptoms and preventing transmission Antiviral Treatment for Genital Herpes.

Aetiology

  • 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.

Epidemiology

  • About 13% (estimate) of the world's population aged 15-49 years were living with HSV-2 infection in 2016 http://www.who.int/bulletin/volumes/98/5/19-237149.pdf.
  • 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.
  • Herpes infection in the oral region Viral Infections of the Oral Mucosa may be transmitted to the partner's genitals through oral sex.
  • 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

  • The symptoms appear 4-14 days after infection.
  • General symptoms include
    • fever
    • headache
    • myalgia.
  • Genital symptoms include
    • vesicles and ulcers (picture 1)
    • stinging pain
    • dysuria
    • inguinal lymphadenopathy
    • ulcerating cervicitis.
  • The lesions are bilateral.
  • The symptoms persist for 2-3 weeks.
  • 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 duration of symptoms is about 7 days.

Diagnosis

Treatment

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]