Anyone who is sexually active can contract genital herpes, and nearly 30% of the adult population is infected. Most people acquire the infection from a partner who is asymptomatic and unaware of the diagnosis.
After being infected, the herpes virus remains in the body for life, and it can be reactivated later to cause new outbreaks. Triggers for outbreaks can include other infections, illnesses, fever (when the immune system is weakened), menstruation, physical stress, and emotional stress. Not everyone experiences recurrent outbreaks, but it is common to have two to three outbreaks per year for several years after the initial infection. If no recurrence occurs within the first six months to a year after the initial infection, the likelihood of future outbreaks is significantly reduced.
Genital herpes is not a dangerous condition, but it can cause significant discomfort (frequent outbreaks, painful sores) and emotional stress. It can also have a negative impact on one's sex life due to the outbreaks themselves and the fear of transmitting the virus to a partner.
The majority of people infected with herpes, have no or barely noticeable symptoms of genital herpes. Only 20% experience typical herpes outbreaks characterized by small blisters (vesicles) that quickly rupture and form shallow sores. Some patients may also have enlarged, tender lymph nodes in the groin area. Less commonly, individuals may experience malaise and fever. Men may have a slight discharge from the urethra, while women may experience increased vaginal discharge and painful urination (in severe cases, it can be too painful to urinate). Swelling of the external genitalia may also occur. The genital sores do not leave scars.
The diagnosis of genital herpes is often based on the appearance of the sores. A swab sample from the sore can be taken and tested using polymerase chain reaction (PCR) to confirm the diagnosis and determine the specific herpes virus type. It is best to take these swabs as early as possible in the course of the outbreak. In rare cases, a blood test may be conducted to detect herpes antibodies.
First-time outbreaks typically last two to three weeks. Subsequent outbreaks are shorter (about one week) and milder. Many patients experience a prodromal phase before an outbreak, characterized by itch or tingling in the area where the outbreak is about to occur, or discomfort in the labia, penis, scrotum, thighs, or buttocks.
Complications of genital herpes can include urinary retention (due to painful urination) or the spread of the virus to other organs (such as the eyes, meninges, etc.). Genital herpes can be severe in pregnant women (especially during the first outbreak) and requires monitoring and treatment by an obstetrician.
Herpes genitalis can be caused by both herpes simplex type 1 (which typically causes oral herpes) and type 2 (often referred to as HSV-1 and HSV-2, respectively). In initial genital outbreaks, these herpes types are approximately equally common. However, recurrent outbreaks are more frequent with HSV-2 infection. Thus, up to 70% of all genital herpes outbreaks are caused by HSV-2.
The herpes virus enters the body through skin or mucous membrane contact. Herpes is not transmitted through shared utensils, glasses, towels, toilet seats, pools, or handshakes. It is also not transmitted through semen or blood.
Typically, it takes less than a week from the time of infection to the onset of symptoms, but in some cases, it can take up to three weeks.
In the case of genital herpes, it is important to start treatment as early as possible. Treatment initiation should occur within 72 hours to achieve optimal effectiveness. If new vesicles and sores develop later in the course of the outbreak, later treatment can still be helpful for some individuals.
Initial outbreaks are treated with antiviral medicine for 5-10 days. Subsequent outbreaks are treated with similar tablets for shorter durations. Pain from sores can be managed with painkillers (such as paracetamol and/or ibuprofen) and local anesthetic gel or cream.
For patients with frequent outbreaks, daily preventive treatment (suppressive therapy) may be considered. This treatment often extends over a period of six months at a time. Generally, the frequency of recurrences decreases over the years, and it becomes possible to discontinue suppressive treatment. However, suppressive therapy does not eliminate the possibility of transmission but reduces the risk.
In women, itch, discomfort, and irritation can be caused by yeast infections or vaginitis. Eczema on the labia or penile head maybe mistaken for genital herpes. Syphilis, a disease that causes genital sores, is another condition that can resemble genital herpes to some extent.
The risk of transmitting the virus to others is highest during the first year after being infected. It is important to avoid sexual intercourse during active outbreaks (vesicles/sores) or when there is suspicion of an impending outbreak.
Condoms can reduce the risk of transmission if used correctly throughout sexual activity, covering all areas where there are sores. However, even if using condoms, individuals with genital herpes outbreaks should refrain from sexual contact.
There is a risk of self-infection to other areas during the first two to three months after an initial outbreak (due to a lack of antibodies). Good hand hygiene is crucial to prevent this.
