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Genital Herpes or Herpes Simplex Virus (HSV)

Overview

The herpes simplex virus (HSV) is categorized into 2 types: HSV-1 and HSV-2. HSV-1 is mainly transmitted by oral-to-oral contact, causing oral herpes (including symptoms known as cold sores), but it can also lead to genital herpes. HSV-2 is a sexually transmitted infection that causes genital herpes. Infection with HSV-2 increases the risk of acquiring and transmitting HIV infection.

Table of Contents:

Symptoms and causes

How does HSV spread?

HSV-1

HSV-1 is mainly transmitted via contact with the virus in sores, saliva, or surfaces in or around the mouth. Less commonly, HSV-1 can be transmitted to the genital area through oral-genital contact to cause genital herpes.

It can be transmitted from oral or skin surfaces that appear normal; however, the greatest risk of transmission is when there are active sores. People who already have HSV-1 are not at risk of reinfection, but they are still at risk of acquiring HSV-2.

HSV-2

HSV-2 is mainly transmitted during sex through contact with genital or anal surfaces, skin, sores, or fluids of someone infected with the virus. HSV-2 can be transmitted even if the skin looks normal, and is often transmitted in the absence of symptoms. In rare circumstances, herpes (HSV-1 and HSV-2) can be transmitted from mother to child during delivery, causing neonatal herpes.

There are some misconceptions about how HSV is spread. It is important to note that, you will NOT get herpes from toilet seats, bedding, or swimming pools, touching objects such as silverware, soap, or towels.

Symptoms

Oral herpes

Oral herpes infection is mostly asymptomatic, but symptoms can include painful blisters or open sores (ulcers) in or around the mouth (cold sores).

Infected persons will often experience a tingling, itching, or burning sensation around their mouth before the appearance of sores.

These symptoms can recur periodically, and the frequency varies from person to person.

Genital herpes

Genital herpes can be asymptomatic or have mild symptoms that go unrecognized. When symptoms occur, genital herpes is characterized by one or more genital or anal blisters or ulcers. Additionally, symptoms of a new infection often include fever, body aches, and swollen lymph nodes. After an initial episode, which can be severe, symptoms may recur.

Genital herpes caused by HSV-1 typically does not recur frequently. With HSV-2, recurrent symptoms are common. However, recurrences are often less severe than the first episode and tend to decrease over time.

When to see a doctor?

Ask a healthcare provider to examine you if:

  • You notice any symptoms; or
  • Your partner has an STD or symptoms of an STD. (STD symptoms can include an unusual sore, a smelly genital discharge, burning when peeing, or bleeding between periods (if you have a menstrual cycle))

Diagnosis and treatment

Diagnosis

Your healthcare provider can usually make a diagnosis of genital herpes based on a physical exam and a history of your sexual activity. To confirm a diagnosis, your provider will likely take a sample from an active sore. One or more tests of these samples are used to see if you have herpes simplex virus (HSV), infection and show whether the infection is HSV-1 or HSV-2. Less often, a lab test of your blood may be used for confirming a diagnosis or ruling out other infections.

Treatment

Antiviral medications – such as acyclovir, famciclovir, and valacyclovir – are the most effective medications for people infected with HSV.

These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

Coping and support

A diagnosis of genital herpes may cause embarrassment, shame, anger, or other strong emotions. You may be suspicious or resentful of your partner. Or you might be worried about rejection by your current partner or future partners.

Healthy ways to cope with having genital herpes include the following:

  • Communicate with your partner - Be open and honest about your feelings. Trust your partner and believe what your partner tells you.
  • Educate yourself - Talk with your healthcare provider or a counsellor. They can help you learn how to live with the condition. They can also help you lessen the chance of infecting others. Learn about your treatment options and how to manage outbreaks.
  • Join a support group - Look for a group in your area or online. Talk about your feelings and learn from others' experiences.

Preparing for your appointment

Be prepared to answer the following questions:

  • What are your symptoms? When did they start?
  • Do you have sores or unusual discharge?
  • Do you have pelvic pain?
  • Do you have pain while urinating?
  • Do you have a new sexual partner or multiple partners?
  • Have you ever been diagnosed with a sexually transmitted infection?
  • Do you regularly use condoms?
  • What medications or supplements do you take regularly?

What to expect from your doctor

Your healthcare provider will talk to you about the right treatment for you. Treatment depends on the severity of the disease, the type of HSV, your sexual activity, and other medical factors. The dose will vary depending on whether you currently have symptoms. Long-term use of antiviral drugs is considered safe.

Your care provider will likely recommend that you get tested for other STIs. Your partner should also be tested for genital herpes and other STIs.

What can you do in the meantime?

Avoid having any form of sexual activity when you or your partner has herpes symptoms (i.e., during an “outbreak”).

People with symptoms suggestive of genital herpes should be offered HIV testing. Pregnant women with symptoms of genital herpes should inform their healthcare providers. Preventing the acquisition of HSV-2 infection is particularly important for women in late pregnancy when the risk for neonatal herpes is greatest.

ABOUT THE AUTHOR
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Dr. Yudara Kularathne
AI & STIs | CEO HeHealth, Consultant Physician (EM), On a mission to impact one billion lives in the next 5 years, Developing AI-driven diagnostic tests for often unspoken diseases.

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