April 20, 2023 Author : Saraiva da Cunha The Herpes simplex virus, or HSV, has two types, HSV-1 and HSV-2. Genital herpes is mainly caused by HSV-2 , transmitted through vaginal or anal intercourse. Many cases of genital herpes are also due to HSV-1 transmitted during oral sex. HSV-1 also causes cold sores, and transmission, which is common in children and youth, is due to direct or indirect contact with infected saliva. The virus can be transmitted from mother to newborn during a vaginal delivery, especially when there are vaginal lesions of the disease. In newborns, herpes infection can have serious consequences. It is estimated that around 13% of the world population aged 15-49 years is infected with HSV-2. How is genital herpes transmitted? In infected people, the virus is found in typical lesions of herpes infection and in body fluids such as saliva, semen and vaginal fluids. Infected people can transmit the virus even when they have no lesions . The virus enters the body through the mucous membranes or a break in the skin. Thus, contagion can happen when there is contact with: Genital and labial herpes lesions and skin in the surrounding areas; Saliva, urine or genital fluids from someone who is infected. Anyone who is sexually active is at risk of getting genital herpes, but the risk is higher and the disease can be more severe: In women; In people who have multiple sexual partners or change sexual partners frequently; In people undergoing treatments that cause immunosuppression; In people who have a weakened immune system, such as those infected with the human immunodeficiency virus (HIV / AIDS). Genital herpes can have potentially serious complications in many organs, including the eyes, liver and central nervous system (encephalitis and meningitis). Genital herpes symptoms Like many other sexually transmitted infections, genital herpes can also have no symptoms and many people may never know they are infected. When the disease has symptoms, they occur in recurrent outbreaks or episodes . The first outbreak usually occurs 1-3 weeks after infection: Small blisters (vesicles) filled with liquid appear on the inner surface of the thighs and/or in the genital area (and inside the vagina in women) and/or in the anal area, which end up bursting, leaving red and painful sores (ulcers), which last for 1-2 weeks and then disappear. In addition to these typical lesions, other symptoms may occur: Pain or discomfort in the genital area, buttocks and thighs; Fever; Muscle aches; Headache; Pain when urinating; Vaginal discharge in women; Enlarged inguinal lymph nodes (in the groin). Over time, there may be several outbreaks of the disease, with lesions and other symptoms of genital herpes. The first outbreak of the genital herpes is usually the most severe and the lesions take longer to disappear; The outbreaks frequency decreases over the years; The frequency and severity of outbreaks varies from person to person. Diagnosis The diagnosis is based on the patient's history, signs and symptoms, and diagnostic tests that distinguish whether we are in the presence of HSV-1 or HSV-2. An analysis of a sample of the lesions or genital fluids may be done. When genital herpes is suspected but no lesions are present, a blood test may be done to confirm or exclude the disease. When genital herpes is confirmed, diagnostic tests for other sexually transmitted infections should be done. Genital herpes treatment A Herpes simplex infection, such as genital herpes, has no cure . The goal of treatment is to decrease the frequency of flare-ups and relieve symptoms . The treatment to be given is determined by medical evaluation, also considering the particularities of each case. In some cases, drug treatment may not even be recommended. When treatment is indicated, it may include antiviral drugs: Taken daily to prevent outbreaks (suppressive treatment, indicated when outbreaks are very frequent), or taken at the first signs of an outbreak to lessen the severity of symptoms and speed up recovery (episodic treatment); Applied locally to lesions. It may help during an outbreak: In injuries, the application of heat (a gauze pad soaked in hot water, for example) or cold (protected ice) relieves the pain or discomfort they cause; In women, sitz baths or even immersion in warm water can relieve pain when urinating and facilitate urination; Wear cotton underwear; Avoid very tight underpants and pants or shorts. Prevention of genital herpes The main measures to avoid becoming infected and not transmitting genital herpes are: Always use a condom during sexual intercourse; Not having sex during an outbreak of the disease, even using a condom; Do not have oral sex when there are labial or oral herpes lesions ; Do not touch herpes lesions ; Reinforce hand washing during an outbreak of illness. W omen who have genital herpes and become pregnant should inform their doctor so that he can advise them on the precautions they should take to protect their child. Sources Albrecht MA. Patient education: Genital herpes (beyond the basics). www.uptodate.com Centers for Disease Control and Prevention. Genital herpes. www.cdc.gov World Health Organization. Herpes simplex virus . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
