Genital Herpes Causes and Treatment

Symptoms

A distinction is made between initial infection and subsequent reactivation. After an incubation period of a few days, flu-like symptoms such as fever, swelling of the lymph nodes, headache, nausea, and muscle pain may occur. The actual genital herpes occurs, with reddened skin or mucous membrane, swelling of the inguinal lymph nodes, and single or grouped, painful, burning, and itchy vesicles that quickly break open and progress to erosions and ulcers (ulcerations). In men, the penile shaft, glans penis, and foreskin are most commonly affected; in women, the vulva, vagina, cervix, and perineum are affected. The skin lesions also occur outside the genital tract, for example, on the thighs, fingers, or face. Purulent secretions and discomfort during urination occur. The lesions heal within a few days with the formation of a crust. The initial infection may persist for several weeks. The herpes viruses remain in nerve cells (ganglia) in the body for life. Genital herpes is a chronic disease. Occasionally, a relapse of the disease occurs due to reactivation of the virus. Shortly before relapses, symptoms such as a feeling of tightness, sensory disturbances, itching, burning or pain, and more rarely fever and swelling of the lymph nodes, appear. The symptoms of relapse are comparable to the initial infection, but the course is shorter and milder. Relapses may be subclinical with no apparent symptoms. An atypical course with various skin lesions is also possible.

Causes

Genital herpes is caused by infection with the double-stranded DNA virus herpes simplex virus type 2 (HSV-2) or type 1 (HSV-1) of the herpesviridae family. Traditionally, HSV-2 has been implicated in more infections, but HSV-1 is gaining importance.

Transmission

Transmission occurs during sexual intercourse through contact with the skin, mucosa, or secretions. The virus is also transmitted during oral sex. Because symptoms do not distinguish between initial infection and reactivation, it is difficult to assess where the infection initially originated. Carriers may be asymptomatic and unaware of their disease themselves. The virus is also transmitted from mother to child, often during birth.

Complications

The skin lesions present a psychosocial challenge and can lead to feelings of shame, frustration, despair, anger, and low self-esteem, limiting quality of life. Many patients are afraid of being rejected by their current or potential sexual partner. In women, local superinfection with Candida fungi (vaginal fungus) is relatively common. Inflammation of the meninges with fever, neck stiffness, headache and sensitivity to light, and encephalitis are rare. In immunosuppressed individuals, dangerous general spread of the virus to various organs is possible. Herpes neonatorum: Transmission to the unborn or newborn child during pregnancy or at birth can cause serious complications such as respiratory distress syndrome, generalized rashes, yellowing of the skin, meningitis, and encephalitis.

Risk factors

For initial infection, the cumulative number of sexual partners is most important. The more there are, the greater the risk for genital herpes. Risk factors for recurrence include injury, various illnesses, immunosuppression, physical stress, UV exposure, heat, cold, the menstrual cycle, and possibly stress.

Diagnosis

Diagnosis is made by medical treatment on the basis of the clinical picture and by detection by various laboratory methods. Possible differential diagnoses include, for example, syphilis, Behçet’s disease, candidamycosis, trichomoniasis, and other skin diseases such as allergic contact dermatitis.

Prevention

For many virus carriers, the question of prevention is important. They want to avoid infecting their sexual partner as much as possible. The following measures, among others, are recommended for prevention. Vaccination is not currently available.

  • Condoms provide good, although not complete, protection against infection (because surrounding skin may also be affected). Carriers of the virus should always wear them during sexual intercourse.
  • Pay attention to hygiene: The burst blisters are highly contagious and should not be touched. Wash hands thoroughly after touching.
  • During reactivation, direct contact and sexual intercourse should be avoided. However, transmission is possible even if no symptoms are apparent.
  • Use topical virucides.
  • Possibly administer suppressive therapy (see below).
  • Inform the sexual partner about their own disease.

Non-drug treatment

Recommended non-medicinal measures include cold compresses, appropriate wound treatment, sitz baths and wearing light cotton underwear.

Drug treatment

Treatment involves causally effective antiviral drugs and symptomatic measures. Permanent elimination of the virus is not yet possible. For treatment of special patient groups (pregnant women, children, immunosuppressed, complications), we refer to the literature. Antiviral drugs:

  • They are considered first-line agents. When applied internally, they are directly effective against the viruses. Nucleoside analogues such as aciclovir (Zovirax), valaciclovir (Valtrex), and famciclovir (Famvir) and corresponding generics in tablet or capsule form are primarily used. The usual duration of therapy has traditionally been 5 days, and full details can be found in the drug label. In recent years, shorter therapy regimens have also been proposed, ranging from 1-3 days, depending on the active ingredient.
  • Antiviral therapy causes relief of symptoms, faster regression of skin lesions, reduced excretion of viruses and a lower risk of complications. It must be initiated as early as possible, within 24-48 hours of the onset of symptoms. In case of frequent and severe relapses, antiviralia are also taken preventively and continuously for 6-12 months as part of a so-called suppression therapy. In case of resistance, foscarnet (foscavir i.v.) is a possible alternative. However, it must be administered parenterally.

How effective externally applied antiviral drugs are, is controversial. In the scientific literature, they are largely rejected. In many countries, only the aciclovir cream (Zovirax, generics) is approved. It must be applied 5 times daily. Other antiviralia are not commercially available for this indication. For example, penciclovir cream (Fenivir, formerly Famvir) is only approved to treat cold sores. Idoxuridine (Virunguent) is out of commerce. Disinfectants:

  • Such as povidoneiodine (Betadine, generic) are germ-reducing. Tanning agents such as tannosynt and oak bark extracts are astringent, anti-inflammatory, and antimicrobial. They are applied topically or administered as sitz baths and can also relieve symptoms symptomatically. Some sources also recommend the drying zinc ointments for the skin lesions.

Painkillers:

Skin care products:

  • Soften the skin as it heals.

Heat inactivated HSV viruses:

  • Heat-inactivated HSV viruses (Lupidon H/G, both off-label) were approved in many countries for the treatment of severe and recurrent herpes infections. They are injected subcutaneously. This delivery of herpes simplex antigens appears to have a beneficial effect on skin lesions. Criticized is the insufficient scientific evidence of efficacy.

The effectiveness of alternative medicines such as L-lysine, lemon balm leaf extract, echinacea, taiga root, bee products, aloe vera or zinc is controversial and scientifically insufficiently documented.