genital herpes

Genital herpes is a contagious viral disease that can affect the skin and mucous membranes of the genital area. It is usually triggered by herpes simplex type 2 viruses (HSV-2).

Herpes simplex type 1 viruses (HSV-1) usually cause the widespread lip herpes (herpes labialis), but are also responsible for 20-30% of genital herpes cases.

Since HSV-1 is easily transmitted to other people through saliva contact or smear infections, antibodies (signs of infection) against the virus can be detected in more than 95% of adults. With HSV-2, this is the case in 10 to 30% of the adult population.

The transmission route for genital herpes is usually unprotected sexual intercourse, whereby the risk for women is higher than for men. The risk of infection is highest in the period shortly before vesicles appear and while they are visible. It is also possible for the virus to be transmitted from the infected mother to the child during pregnancy or birth.

The symptoms of genital herpes are triggered by the attack of the herpes simplex virus on cells of the epidermis, resulting in the formation of fluid-filled blisters that contain a large amount of virus. From there, the virus enters the nerve endings of sensitive neurons and travels along the nerve pathways to the ganglia (switching points between nerves), where it settles and can remain in a kind of dormant state (latent phase) for life. Especially in immunocompromised persons (for example, as a result of surgery, immunosuppression after organ transplantation or AIDS), the herpes simplex viruses can be reactivated from their dormant state, spread throughout the body and cause serious diseases.

The incubation period after the initial infection with genital herpes is between 2 and 12 days. Subsequently, mild symptoms such as fever, swollen lymph nodes, headache and muscle pain as well as burning pain on the genitals, anus or when urinating may occur. In the genital area, small, light-coloured blisters develop on a reddened skin area. These often lie close together in small groups (herpetiform) and heal after about two to three weeks. The infection can be completely free of symptoms in some people.

If an infection with the herpes simplex viruses occurs in newborns (for example during birth), this can lead to a life-threatening condition with high fever and the development of vesicles all over the body.

Since an infection almost always leads to persistence of the virus (the pathogens remain dormant for life in certain retreats in the body and cannot be completely eliminated by the immune system), the virus can be reactivated at any time and trigger genital herpes again. The first signs of this are unpleasant tingling or stinging sensations in the genital area. Within a few hours or days, small blisters may reappear on the skin, which in severe cases can spread from the genitals to the thighs and buttocks.

Oral sex may also cause the symptoms described above in the mouth and throat. When practicing anal sex, an infection of the anus is possible, which can lead to bloody discharges and pain at the anus.

Furthermore, it is possible that the reactivation of the herpes simplex viruses can occur without any symptoms. It is important to know that even during this apparently symptomless period, virus particles are excreted through the mucous membranes and can infect other people.

The course of the disease and the typical rash in the genital area give the attending physician an initial indication of the presence of genital herpes. However, a reliable diagnosis can only be made by means of a laboratory examination. For this purpose, a swab of the fluid-filled vesicles is taken, which is then examined in the laboratory using an electron microscope or PCR (polymerase chain reaction for the detection of viral DNA). Another possibility is the detection of antibodies against the virus in the blood.

For the treatment of genital herpes, viral drugs (antiviral agents such as aciclovir, valaciclovir, famciclovir) are used, which can shorten the course of the disease and alleviate the symptoms. The earlier the medication is taken, the greater the success of the therapy - therefore, in the case of a first infection, treatment with medication usually begins immediately after the physical examination, even before the confirmed results of the laboratory examination are available.

Systemic administration of the drugs (oral tablets, intravenous injection) is many times more effective than local application with ointments. In addition to viral drugs, which are taken over a period of five to ten days, it is sometimes necessary to take a painkiller. In case of poor general condition or symptoms such as stiff neck or confusion, inpatient treatment in a hospital is necessary.

If sufferers have more than six outbreaks of genital herpes per year, long-term therapy with viral drugs may be useful to reduce the number of attacks. After about a year, treatment should be suspended to check whether the number of herpes outbreaks may have remained low in the meantime, even without medication.

Virustatics against genital herpes are not approved for treatment during pregnancy. However, they are still prescribed in individual cases to protect the newborn from infection with the herpes viruses.

The course of a genital herpes disease varies greatly from person to person - ranging from sufferers with monthly outbreaks to patients with periods of dormancy lasting for years. The type of virus also plays a large role in the severity of the disease, as infections with herpes simplex virus type 2 have a much higher frequency of outbreaks than type 1. People with a weakened immune status also experience more frequent outbreaks. However, genital herpes occurs less frequently with increasing age.

After an infection has occurred, the virus usually remains in a kind of dormancy in the body for life (called persistence) without triggering any symptoms. Under certain circumstances, such as stress, immunosuppression, other diseases or hormonal fluctuations during the menstrual cycle, the virus can be reactivated and trigger genital herpes again.

Complications that can occur with genital herpes include the following:

• Bacterial infection can occur at the herpes blisters, causing a focus of inflammation.
• Genital herpes can spread to the eyes, leading to impaired vision.
• During pregnancy, infection of the unborn child is possible. The unborn child usually falls seriously ill, often with fatal consequences.
• Infection with herpes viruses during birth can cause serious illnesses in the newborn, such as encephalitis (inflammation of the brain) or sepsis (blood poisoning).
• In immunocompromised persons (AIDS patients, immunosuppression as a result of organ transplantation), herpes simplex viruses can trigger severe pneumonia.

Since genital herpes is primarily transmitted through sexual contact such as intercourse or oral sex, the consistent use of condoms offers good protection against infection.

In case of a possible disease, it should be clarified by a doctor as early as possible in order to prevent the progression of the disease and to keep the risk of infection for any sexual partners low.