Genital herpes

Genital herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV). It primarily affects the genital region and is classified into two types: HSV-1 and HSV-2. While HSV-2 has historically been more prevalent, HSV-1 is becoming increasingly common in the developed world. The infection is widespread, with an estimated 846 million people affected globally as of 2015.

Signs and Symptoms

The majority of those infected with genital herpes are asymptomatic or have mild symptoms that go unnoticed. When symptoms do occur, they often include small blisters on the genitals that break open to form painful ulcers. Flu-like symptoms such as fever, muscle aches, and swollen lymph nodes may also be present.

In males, lesions typically appear on the glans penis, shaft, inner thigh, buttocks, or anus. In females, they are often found on the vulva, pubis, clitoris, buttocks, or anus. Additional symptoms in women can include painful urination and cervicitis. Lesions generally heal within a few weeks but may leave a lasting impact, such as recurrent outbreaks.

Recurrence

Recurrence is a common feature of genital herpes. Approximately 80% of people with HSV-2 and 50% with HSV-1 experience at least one recurrence. HSV-2 tends to recur more frequently, averaging four to six times per year, compared to HSV-1, which typically recurs about once a year.

Suppressive therapy with antiviral medications like acyclovir, valacyclovir, or famciclovir can reduce the frequency and severity of recurrences. This therapy is especially advised for individuals with multiple outbreaks annually.

Transmission

Genital herpes is primarily spread through direct genital contact with an infected person’s skin or secretions. Transmission can occur even in the absence of visible sores. The risk of transmission between couples is about 7.5% per year. Condom use can reduce this risk by 50%. Antiviral medications can further decrease the likelihood of spreading the virus.

Prevention

Preventive measures include abstaining from sexual activity, using condoms, and limiting the number of sexual partners. Testing for HSV is recommended for individuals with symptoms or those with an infected partner. Suppressive antiviral drugs are effective in significantly reducing transmission rates.

Screening and Diagnosis

Diagnosis is typically made through a physical examination or testing lesions using PCR or viral culture. Blood tests for HSV antibodies can also be conducted. Routine screening for asymptomatic individuals is not recommended due to the potential for false-positive results, which may lead to unnecessary anxiety.

Genital Herpes and Pregnancy

Women with genital herpes before pregnancy have a low risk of transmitting the virus to their baby during delivery. Caesarean sections are recommended for symptomatic women at the time of delivery to prevent transmission. Antiviral treatments like acyclovir may be used from 36 weeks of gestation to reduce the risk of recurrence and transmission.

Treatment

There is no cure for genital herpes. However, antiviral medications such as acyclovir, valacyclovir, and famciclovir can shorten outbreaks, reduce symptoms, and prevent recurrences. These medications can be used during the first clinical episode, for recurrent outbreaks, or as daily suppressive therapy.

First Clinical Episode

For the initial outbreak, treatment options include:

• Acyclovir 400 mg orally three times a day for 7–10 days
• Valacyclovir 1g orally three times a day for 7–10 days
• Famciclovir 1g orally twice a day for 7–10 days

Recurrent Genital Herpes

Recurrent outbreaks can be treated with episodic or suppressive therapy. Long-term use of antivirals has been shown to be safe and effective in reducing recurrence and transmission.

Over-the-Counter and Non-Drug Treatments

Symptomatic relief during outbreaks can be achieved through:

• Applying ice packs
• Taking warm baths
• Keeping the genital area dry
• Using over-the-counter pain relief medications like ibuprofen or acetaminophen

Epidemiology

Genital herpes is one of the most common STIs, with about 16% of Americans aged 14 to 49 infected. Despite its prevalence, many remain unaware of their infection. Regular STI screenings usually do not include tests for herpes due to issues with test accuracy and utility.

History and Research

Initially overlooked in public health legislation, genital herpes gained attention after the development of acyclovir in the 1970s. Efforts to develop a vaccine are ongoing but have yet to produce definitive results.

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Self-assessment MCQs (single best answer)

What virus causes genital herpes?

Which of the following is becoming increasingly common in the developed world for causing genital herpes?

What percentage of people with HSV-2 experience at least one recurrence of genital herpes?

Which antiviral medication can be used for suppressive therapy in genital herpes?

What is the approximate annual risk of transmission of genital herpes between couples?

Which method is NOT typically recommended for routine screening of asymptomatic individuals for genital herpes?

During which period is antiviral treatment recommended for pregnant women with genital herpes to reduce the risk of recurrence and transmission?

What is the recommended dosage of acyclovir for the first clinical episode of genital herpes?

Which of the following symptoms is NOT commonly associated with genital herpes in females?

Which of the following preventive measures is LEAST effective in reducing the transmission of genital herpes?