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Genital Herpes

Genital herpes is a very contagious sexually transmitted disease (STD) caused by the Herpex Simplex Virus. There are two types, Herpex virus type 1(HSV-1) and type 2(HSV-2). Although both can be found in the genital area, HSV-1 is associated with orofacial disease and type 2 is more associated with genital disease.


What is genital herpes?

This disease causes herpetic sores or blisters that are filled with fluid that break open and spread the fluid it contains in areas that surround the first blister or sore. It has no cure and depending on factors such as stress, and immunocompetence, the lesions may reappear through time.

How common is it?

According to recent studies, there are over 23 million cases worldwide reported every year and it is more prevalent in black women (55%) followed by 35% in black men, 20% in white women and 15% in white men. 20% of people infected with HSV-2 type have no symptoms and 60% of infected people have symptoms that aren’t typical to be found. Therefore, there is a higher prevalence in women than in men. HSV-1 is more common in children since they haven’t developed antibodies to fight the virus. HSV-2 is more common in people in reproductive age from 14 to 69 years old. Children with genital herpes should be tested for sexual abuse. 

How is herpes transmitted?

Herpes is one of the most common sexually transmitted diseases, therefore it is most commonly transmitted through sexual intercourse.

You can get genital herpes by:

  • Direct skin to skin contact by oral, vaginal and anal sex into a lesion or mucosa.
  • Using sex toys from someone who has the disease.
  • HSV-1 can be transmitted by contact with infected saliva.
  • HSV-2 can be transmitted from mother to child through birth
  • Both can be transmitted through saliva, semen and vaginal secretions.

What are the signs and symptoms of HSV?

Two thirds of people that are infected with herpes are asymptomatic,  meaning they don’t have any symptoms or the signs and symptoms they present are so mild that they don’t know they have the disease. Symptoms may be present as early as the second day of infection and 30 days after. Normally it is found from 2 to 12 days after exposure.

  1. Pain or itching: This is one of the most common symptoms. It is also one of the signs that lets people know that an outbreak will reoccur e as a warning sign. Pain will be located where the first blister or lesion will show itself. Pain will present itself as a tingling or shooting type of pain located in legs, buttocks or hips. In women, pain will also be located in the genital area and may cause pain while urinating. It may last from a couple of hours to two days.
  2. Blisters or bumps: They will appear from 2 days to a a couple of weeks after infection. They will appear as small red bumps or small white blisters filled with liquid. In women, they will appear in the labia, introitum and cervix. In men it may appear in the gland, shaft, prepuce, thighs and buttocks.
  3. Sores or ulcers: They will appear once the blisters burst and spread in areas close to the first lesion. They last from 4 to 15 days and shedding occurs around the 12th day.
  4. Other symptoms: People may present flu-like symptoms such as:
  • Fever
  • Headaches
  • Body aches
  • Swollen lymph nodes
  • Dysuria: Pain while urinating

What can trigger a genital herpes outbreak?

Herpes has no cure, therefore people who become sick will experience outbreaks throughout their lifetime. The causes for outbreaks are still being studied, although it is highly associated to a weakened immune system, stress,  hormonal changes such as menstruation, lesions in skin or extreme climate weather. Sun beds and exposure to UV rays has also a high association to herpes.

For people who experience a first episode of genital herpes, outbreaks or reactivation of the disease is more common, so expect from 5 to 6 episodes in a year. The outbreaks will then be less frequent and the severity of them will be milder.

How can you avoid the risk of getting genital herpes?

Genital herpes is a sexually transmitted disease, therefore, the only way to avoid getting it is abstinence. If you are already sexually active, there are certain things you can do to avoid having herpes.

  • Long-term monogamous relationships with partners who have no STD’s.
  • Use latex condoms every time you have sex. Even though it doesn’t protect you 100%, it will lower the risks of suffering this disease. Herpes may appear in areas that are not completely covered or protected by a condom, therefore, even if you use it correctly, you are still susceptible of suffering this disease.
  • Avoid having multiple partners.
  • If your partner already has genital herpes, always protect yourself using condoms, and have your partner take anti-herpes medication everyday. If your partner has an outbreak, avoid having sexual intercourse while the episode occurs.

What are the complications associated with genital herpes?

  • Sexually transmitted disease: HSV virus can predispose people to suffer other sexually transmitted diseases such as chlamydia, gonorrhea, and HIV.
  • Urethritis: Sores can cause inflammation around the urethra, making it impossible for urine to pass correctly. A catheter may be inserted to let the urine drain from your bladder in extreme cases.
  • Eczema herpeticum: A complication that occurs in people that have an underlying skin condition
  • Newborn transmission: If you are pregnant and suffer from recurrent outbreaks, the virus can pass on to your baby leading to blindness, brain damage and death of the newborn. Without proper treatment,  up to 65% of newborn babies may die.
  • Meningitis: The virus can infect your cerebrospinal fluid and membranes. The membranes give nutrients and protects your brain. Once they are infected they become inflamed and can cause brain damage or death.
  • Respiratory tract infections: They are more common in children. Symptoms usually last about 2 weeks and involve the epiglottis, larynx and trachea. Pneumonia is rare but it usually follows complications from upper respiratory tract infections.
  • Super infections: Because of the skin lesions, it is more likely for you to suffer from fungal or bacterial super infections. Balanitis or infection of the foreskin may occur in men and candidal vaginitis has been observed in women.

How is genital herpes diagnosed?

If you present the symptoms presented above, en sure to visit a doctor for proper treatment. Usually, doctors make a diagnosis by looking at the lesions. The standard test used for diagnosis is the tissue culture. This type of test can identify and distinguish which type of herpes simplex you have. Positive results can be provided 48 hours after infection. Other complementary exams include: complete blood count, Tzank smears, Polymerase chain reaction (PCR) and antibody testing. It is recommended to get tested for other sexually transmitted diseases such as chlamydia, gonorrhea and HIV if you test positive for HSV. 

How is genital herpes treated?

Antivirus treatment is given to control the virus from multiplying inside your body, therefore making the symptoms and signs less visible. Treatment is different if this is your first outbreak or if you suffer from recurrent outbreaks. Severity and quantity will determine the type of medication your doctor will give you. There are two medications that are used, your doctor will decide which medicine best suits you. It is important to take the medication within 24 hours of onset of symptoms. The earlier you take the medicine it will be more effective and may even make the disease last 1 to 2 days less than not taking any medication.

The episodes limitate itself and don’t last over 15 days, so treatment is not always necessary. Other medications such as over the counter pain killers may be taken to diminish the pain symptoms. Be sure to always let your doctor know what other medications you take to avoid interactions with these medications. Let your doctor know if you suffer from other type of diseases, such as kidney and liver failure, hematologic diseases or if you suffer from another sexually transmitted disease. 

Acyclovir Valacyclovir
Tablets: 400 mg 800 mg Tablets: 500 mg 1 g
Initial Treatment: 200 mg orally every 4 hours for 10 days or 400 mg orally every 8 hours for 17 to 10 days Initial treatment: 1 g orally every 12 hours for 10 days.
Intermittent treatment for recurrent episodes: 200 mg orally every 4 hours for 5 days Recurrent episodes: 500 mg orally every 12 hours for 3 days. Treatment should start within 24 hours from onset of symptoms.
Chronic suppression for recurrence: 400 mg orally every 12 hours for up to 1 year. Alternating 200 mg 3 to 5 times a day. Suppressive therapy: 1 g orally, every day. Suppressive therapy for patients with >9 recurrent outbreaks: 500 mg orally every day. Transmission reduction therapy: 500 mg l every day. Suppressive therapy for HIV positive patients: 500mg every 12 hours, every day.
Cautions: Use with caution if you suffer kidney disease or suffer from immune diseases. For treatment to work properly, it should be taken within 24 hours of first symptoms to appear. It may be used during pregnancy. Cautions: Use with caution in immunosupressed, elderly or patients with renal disease. Treatment should start within 72 hours of symptom onset. It may be used in pregnancy. Caution should be taken when breastfeeding.
Side effects: Headaches, diarrhea, vomiting and nausea. Agitation, alopecia (hair loss) abdominal pain, dizziness and fatigue. Side effects: Headaches, nausea, abdominal pain, depression, neutropenia, elevated liver enzymes, dizziness, rash, vomiting, dysmenorrhea( menstrual pain), white blood cell alteration, alopecia, confusion, hypertension and visual disturbances.

What should you do if you suffer from genital herpes and you’re pregnant?

If you’re pregnant and suffer from genital herpes, you should let your doctor know about this. Precautions will be taken so that a vaginal delivery is avoided. A cesarean delivery is recommended to avid transmission to your newborn baby. Your GP will be able to give you the right treatment for you and your baby. If you have an outbreak, be sure to visit your doctor to receive the adequate treatment. There are many complications associated with babies if you don’t receive treatment. After the 36th week of pregnancy it is recommended that pregnant women take medicine to avoid an outbreak during delivery. 

Is genital herpes associated to HIV?

Genital herpes is a sexually transmitted disease. As all other diseases, people are more predisposed to suffer from ther sexually transmitted diseases. Because of the sores and skin lesions, it is more likely for you to get infected from HIV.  If you suffer from both diseases, be sure to let your doctor and sexual partner know. It is more likely to infect someone else if you suffer from both diseases.

What are other recommendations you can do when you suffer a herpes outbreak?

Once you have an outbreak, there are certain things you can do to avoid symptoms being so severe.

  • Always keep the area of infection clean to avoid the blisters and sores being infected. Salt water or plain water can help you prevent this.
  • To soothe the pain, an ice pack applied in the area will help you. Avoid putting ice directly onto your skin.
  • Apply Vaseline or petroleum jelly to keep the sores moisturized. Avoid contact with other parts of your body so that the infection doesn’t spread.
  • Creams that contain lidocaine can be used to avoid the pain during urinating.
  • Wash your hands before and after using creams or petroleum jelly.
  • Avoid tight clothing and underwear that may cause friction. Sores and blisters might burst contaminating and spreading the infection in more places of your body.
  • Avoid any sexual intercourse while you have an outbreak until your blisters and sores are completely healed and disappeared. This includes oral, vaginal or anal intercourse.
  • Don’t share sex toys with other people. Be sure to always wash them before and after use. Using a latex condom during use is recommended.