Herpes

Genital Herpes is a viral infection transmitted with sexual intercourse caused by the Herpes Simplex Virus (HSV). Symptoms include sores in the genital and/or anal area, lips, or oral cavity. We cannot eradicate HSV from the body. Even if Herpes goes away on its own without medication, outbreaks and relapses can be treated with local creams or tablets to minimize the symptoms and speed up the recovery. When relapses are too frequent, we might prescribe continuous suppressive therapy (long-term daily pills).

Why Herpes infection is relevant

Herpes Virus infection is one of the most frequent Sexually Transmitted Diseases (STD). Since it affects 15-20% of people aged 14 to 49, the likelihood of getting infected is significant after the first sexual intercourse. After the outbreak, the disease becomes dormant and alternates between symptomatic relapses and silent periods. In some cases, relapses are so frequent as to heavily affect the quality of life of patients and their partners.

The skin swab test and sometimes the urine analysis are helpful for diagnosis. We test the serum antibodies to know if one was already exposed to the infection. 

Mechanism of Herpes infection explained

The Herpes Simplex Virus causes a chronic long-life infection. There are two types of herpes virus: Herpes Genitalis (HSV-2) and Herpes Labialis (HSV-1). Both can spread during vaginal, anal, or oral sex with someone who has even mild symptomatic disease. The transmission occurs through contact with a herpes sore, saliva, genital secretions, skin, or oral mucosa of the affected partner.

Where the virus enters the body, it produces the typical skin abnormality (sore) in 1-4 weeks after sexual exposure (incubation period). The sores are full of Herpes Virus and are highly contagious. One touch is enough to get infected. After complete skin or mucosal healing, the infection becomes silent, and the virus hides inside the nerves supplying the skin or mucosal area. Periodically the virus unhides, migrating through the nerves to the skin and producing the relapse. Many people might have mild or no signs of infection but shed virus intermittently in the anogenital area. As a result, people unaware that they have Herpes can still spread the disease.

In the first outbreak, the specific antibodies are not readily available because the immune system does not recognize the new infection. Therefore, the disease is more severe, and sores spread in an extended area of genital skin or mucosa. Moreover, the condition may compromise the general status with fever and malaise due to the immune reaction against the virus.

After the first outbreak, the no-neutralized viruses go through the peripheral nerves and colonize their roots, becoming dormant in a place where the immune system cannot reach them. From there, they may become virulent and come back through the same peripheral nerves reaching out the skin or mucosa which entered the first time. The recurrences are less intense because the antibodies, which are already in the blood, effectively neutralize most of the virus particles. In relapsing Herpes, the general symptoms like fever and malaise are uncommon, and the skin or mucosa abnormalities affect a smaller area.

The belief that people can get infected from public toilet seats, bedding, or swimming pools, or from touching objects such as silverware, soap, or towels, is unlikely.

Symptoms

The infection may affect the genital skin or the mucosa of the urethra in men and the external genital and the vaginal mucosa in women. The infected site looks like a painful red patch that progresses into small blisters full of liquid containing the virus. These blisters usually break up, becoming very painful and releasing the virus that can infect further. When the blisters dry up, they cover with a crust that goes away in small fragments, leaving the underlying skin healed. The healing process may take 1 to 4 weeks.

The first outbreak is more severe with general symptoms (fever and malaise) and a wider spread of sores on the skin or mucosal surface.

If the disease affects the mucosa of the urethra, the urination will be painful and difficult. Sometimes the patient requires a temporary catheterization to empty the bladder.

People experiencing an initial outbreak of Herpes may have future relapses. Repeat outbreaks are usually less severe than the first outbreak without fever or malaise.

Diagnosis

We can do the swab test to demonstrate an HSV infection with typical skin signs and symptoms. The swab helps us differentiate this infection from other skin infections with similar symptoms in atypical cases. If there are no skin abnormalities, the patient has severe dysuria, and we suspect HSV infection, urine analysis will be warranted. In completely no-symptomatic patients, we can test the antibodies in the blood to know if the patient has already been infected.

Treatment

A definitive cure does not exist. It means that there is no treatment to eradicate the virus. Outbreak and recurrences can be treated with local creams or tablets to minimize the symptoms and speed up the recovery. One of these anti-herpes medications can be taken daily, making spreading infection less likely during sexual intercourse. Similar chronic medications may help people with frequent recurrences.

External Resources

CDC – Center for Disease Control and Prevention – U.S. Department of Health & Human Services

https://www.cdc.gov/std/herpes/stdfact-herpes.htm