Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder. The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected. This may occur during sex, including anal, oral, and manual sex. Sores are not required for transmission to occur. The risk of spread between a couple is about 7.5% over a year. HSV is classified into two types, HSV-1 and HSV-2. While historically HSV-2 was more common, genital HSV-1 has become more common in the developed world. Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies. Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected. Once infected, there is no cure. Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur. The long-term use of antivirals may also decrease the risk of further spread. In 2015, about 846 million people (12% of the world population) had genital herpes. In the United States, more than one in six people (17%) between the ages of 14 and 49 have the disease. Women are more commonly infected than men. Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010. There was a 51.97% global increase in cases of genital herpes between 1990 and 2021. Prevalence increased in South Asia, Southern Sub-Saharan Africa and Central Europe. People aged between 15 and 49, in Southern Sub-Saharan Africa experienced the highest incidence rates of these regions. Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed to HIV-positive individuals, and spread to the baby during childbirth resulting in neonatal herpes.
Signs and symptoms
In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus. Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise. Women often experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal intercourse. After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts. In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash. Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined.
Recurrence After a first episode of herpes genitalis caused by HSV-2, there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%. Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year. People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir. Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor. People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy. Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency.
Transmission Genital herpes can be spread by viral shedding prior to and following the formation of ulcers. The risk of spread between a couple is about 7.5% over a year (for unprotected sex). The likelihood of transferring genital herpes from one person to another is decreased by external condom use by 50%, by internal condom by 50%, and refraining from sex during an active outbreak. The longer a partner has had the infection, the lower the transmission rate. An infected person may further decrease transmission risks by maintaining a daily dose of antiviral medications. Infection by genital herpes occurs in about 1 in every 1,000 sexual acts.
Prevention Because herpes simplex virus (HSV) infection is common and not routinely screened for in the general population, complete prevention of the transmission of genital herpes is difficult. To reduce the chance of contracting herpes simplex virus, external condoms for the penis may be used during oral sex, vaginal sex, and anal sex. Internal condoms for the vagina may be used during oral sex or vaginal sex. Internal condoms and external condoms should not be used simultaneously. Dental dams may be used during oral sex involving the vagina or anus. Decreasing the number of sexual partners a person has may also decrease the chance of contracting HSV. People who have sexual relations with others may get tested for HSV. In people who have been diagnosed with genital herpes, transmission to others may be prevented through suppressive antiviral drugs. This option is 90% effective in preventing the transmission of HSV and is a commonly used option for sexual and/or romantic partners or those who plan on becoming pregnant. Those who are aware that they have genital herpes should notify their partner(s).
… excerpt ends here. Continue reading the full article.
