Genital Herpes

Genital Herpes in one of the common sexually transmitted disease which affect both males and females. It is estimated that 1 in 5 women and one in 9 men have HSV infection. Unfortunately, 80% of the individuals are unaware of the infection.

Herpes simplex virus infection is usually acquired through a contact with mucosal surface of a person excreting the virus. The virus belongs to a member of the Herpes viridae family. It has a double stranded DNA. It causes infection in sensory nerves and establishes latency in the regional dorsal root or sensory ganglion. From there, it can reactivate and travel down the axon to the mucosal or epidermal surface, where it can shed or cause clinical manifestations. The cause for viral reactivation is not well understood.

There are two types of Herpes Simples virus, HSV-1 and HSV-2, which are distinguished by their surface glycoprotein (gD). The most common cause of genital herpes is due to infection of HSV-2, but at least 10% is due to HSV-1. Thought genital herpes with HSV-1 is minimal, but recently there is much increase in rate of primary genital HSV due to HSV-1.

Initially virus gain entry through mucous membrane like oral vaginal and penis. Soon after, virus attack the area and replicate itself, in a meantime it gain access to nerve cell end-plates and through nerve axon, it then travel to more deeper nerve cells and finally stays in regional dorsal root or ganglions. Usually HSV-1 resides in the trigeminal ganglion; HSV-2 resides in the sacral ganglia. Though transmission usually occurs during ano-genital contact, it can also occur during oro-genital contact. Usually Hsv-1 is transmitted through mouth to ano-genital areas. HSV-2 rarely transmits from ano-genital area to mouth. Transmission from mother to her baby has been reported but is rare. Usually transmission occurs during labour, delivery, transplacentally or after birth from mother secretions.

Symptoms of Genital Herpes

It is estimated that more then 70% of all genital HSV-2 infection are transmitted during their asymptomatic periods, as individual are unaware of their infection. After one gets infected, initial symptoms may be seen between 3 days to 2 weeks. Symptoms of primary infection may include headache, malaise, anorexia, fever, edema and lymphadenopathy. In secondary infection there may or may not be any clinical symptoms and if present, are usually mild. But in absence of symptoms patients may still shed the virus, so one may unknowingly infect other individuals. During the primary infection of HSV, one may present with painful vesicles or sallow ulcers on their genital areas which may be present bilaterally and with red base.

In several cases, the presentation may be atypical, so necessary lab tests are required in order to exclude other possible disease. Other possible causes might be fixed drug eruption, scabies, yeast, cervicitis, and vulvu-vaginitis. The most common lab test is viral culture with identification of viral type. The specimen is obtained by rubbing the base of the lesion with swap. Antigen detection tests are also available and the performance characteristics are similar to viral culture .Antibodies to HSV can also be detected but in case of initial infection, it might not be useful, as to develop antibodies to HSV it can take as long as 2-12 weeks.

If untreated, several complications might arise, which may include pneumonitis, hepatitis, disseminated infection and central nervous infection like encephalitis and meningitis. Once HSV infection occurs, there is no cure, but can be treated and minimize its recurrence. As HSV recurrence rate is very high, which means patients may experience 4-5 episodes of recurrence per year, especially if the primary infection time is more then 34 days.

Genital Herpes Treatment

As there is no cure, so therapy is based on relieving patients symptoms, early healing of lesion and to decrease the duration of symptomatic shedding. Some antiviral therapy has been used with much success and has shown to decrease the duration and severity of disease. But to get its maximum effect, one should begin treatment as early as possible. Several researches have shown that topical treatments are not beneficial for genital herpes. Based on the recommendations, there are 3 oral antiviral agents which includes Acyclovir, Famciclovir and valacyclovir.

The recommended dosages are:
Acyclovir 400 mg orally 3 times a day for 7-10 days
OR
Acyclovir 200 mg orally 5 times a day for 7-10 days
OR
Famciclovir 250 mg orally 3 times a day for 7-10 days
OR
Valacyclovir 1 g orally twice a day for 7-10 days

In case of recurrent outbreak and for those sexually active and with multiple partners, suppressive therapy with antiviral agents is recommended. Suppressive antiviral therapy reduces herpes outbreaks, viral shedding, and the risk for HSV transmission.

The recommended dosages are:
Acyclovir 400 mg orally twice a day
OR
Famciclovir 250 mg orally twice a day
OR
Valacyclovir 500 mg orally once a day
OR
Valacyclovir 1.0 g orally once a day

In some cases recurrent episodic therapy may also be used. As early treatment is more effective, one can store the antiviral agents and take whenever genital herpes outbreak occurs.

Recommendation dose are:
Acyclovir 400 mg orally 3 times a day for 5 days
OR
Acyclovir 800 mg orally twice a day for 5 days
OR
Acyclovir 800 mg orally 3 times a day for 2 days
OR
Famciclovir 125 mg orally twice daily for 5 days
OR
Famciclovir 1000 mg orally twice daily for 1 day
OR
Valacyclovir 500 mg orally twice a day for 3 days
OR
Valacyclovir 1.0 g orally once a day for 5 days

As it’s an important public health issue and a medical condition which may affect ones sexual life and cause significant psychological and social distress to individual, so every preventive measures like restricting multiple sexual partner, screening and safer sexual activities must be practiced. Early diagnosis and treatment may prevent from complications, its recurrence and chances of transmission to another individual.