Infection in the genital area with the herpes simplex virus is one of the most common sexually transmitted diseases. However, over half of those affected are unaware of their infection and thus continue to spread the virus unnoticed.
From microbes and humans
“Herpes” is the colloquial abbreviation for an infection with the herpes simplex virus (HSV). It usually refers to blisters on the lips and face (herpes labialis). These are usually caused by HSV type 1 and usually appear for the first time in childhood. That there is also a herpes infection in the genital area is less known. Its brother, HSV type 2, is usually responsible for this, although type 1 is the culprit in 20-30% of cases. Both forms have in common that they do not disappear from the body after the initial infection, but settle down domestically in nerve endings. As soon as the attention of the body’s immune defenses wanes or turns to other things, the viruses multiply and migrate to their preferred sites on the skin and mucous membranes. Usually this is then accompanied by a typical blistering episode.
Frequency
How often the viruses reappear year after year varies greatly from person to person. Overall, the frequency and severity of outbreaks decrease with age. However, such reactivations can also occur without symptoms. This is particularly treacherous, as the viruses can still multiply and – unnoticed by the affected person – be excreted through the mucous membranes and thus be passed on. The second dangerous aspect is that herpes and AIDS viruses reinforce each other, i.e. mutually increase the risk of becoming infected with the other disease as well as its manifestation. Experts are concerned that this could trigger a vicious circle leading to an HIV epidemic. For example, according to the World Health Organization, in eastern and southern Africa, the proportion of HIV infections that first developed through HSV infection is estimated to be 60-80%!
Hard facts and dark numbers
Both types of viruses are very common worldwide. In Germany, nearly 90% of the population comes into contact with type 1 during their lifetime; for type 2, it is about 15%. In the United States, the proportion is slightly higher, at 22%. Overall, infection rates worldwide appear to be slowly increasing in recent years; however, studies here suggest that infection in Germany is on the decline. Pregnant women with genital herpes are at risk of transmitting the infection to their child during birth (herpes neonatorum). This occurs in about one in 7,500 births. The risk of transmission is particularly high (30-50%) if the pregnant woman becomes infected in the last third of pregnancy. In 25-40% of cases, the child suffers from life-threatening brain inflammation (encephalitis) and blood poisoning (sepsis), which is fatal in 80-90% of cases. Delivery in such cases is by cesarean section. If the pregnant woman already suffered from a herpes infection in the past, the risk for the newborn is much lower. It is being discussed whether general screening will help to identify possible high-risk births in time. Currently, this is considered useful only for patients at high risk for STDs, HIV-infected persons, and persons whose partners are infected with HSV-2.
Symptoms and progression
After the initial infection, redness and swelling of the genitals – in men mainly the glans, foreskin, or shaft of the penis, in women the labia and vagina – occur 2-7 days later, often accompanied by a feeling of tightness, itching, burning, and pain, as well as glazed discharge. If the viruses were transmitted during oral or anal intercourse, the symptoms appear at the corresponding site. A short time later, grouped, fluid-filled blisters develop, which break open 1-2 days later, then dry up, crust over and heal about 2-3 weeks later without scarring. During this time, there is a risk of infection. The lymph nodes in the groin may swell and there may be general symptoms of illness such as faintness, headache, muscle aches and fever, especially during the initial infection. In principle, herpes genitalis infections are much more painful than “normal” cold sores.Complications include grafting of a bacterial infection onto the pre-damaged skin and, especially in patients with immunodeficiency, spread of the infection throughout the body with inflammation of the lungs, liver, or brain.
Detection and therapy
In most cases, the course of the disease and symptoms already provide decisive clues. The viruses are detected by culturing vesicle contents on special culture media. An additional blood test shows whether the immune system has produced antibodies, i.e., whether an infection has occurred. For treatment, virus-inhibiting agents (antivirals, e.g. aciclovir) are used in the form of tablets or ointments. In severe cases, infusions can also be given. The drugs relieve the symptoms and shorten the healing period; however, the viruses remain in the body. Sex should be avoided during symptoms and treatment. Touching the affected areas should be avoided so as not to transmit the pathogen to other parts of the body. Current drug studies give hope that a vaccine will also be available in the foreseeable future. Currently, two agents are being tested, but still with some childhood diseases: For example, one protects only women, and the other stimulated the immune system but then showed no efficacy in clinical trials.
To the point
- Genital herpes is common worldwide and is usually caused by HSV type 2. The virus remains in the body for life.
- Herpes and AIDS viruses reinforce each other.
- Many affected people do not know about their infection. The infection occurs through mucosal contact or contact with the contents of the vesicle.
- Condoms (also during oral sex) protect against infection.
- Therapy with aciclovir removes only the symptoms.
