Genital herpes is a common viral infection (herpes simplex virus II, HSV-2) which is primarily transmitted through sexual contact. The initial virus infection is called primary infection and has a more pronounced clinical picture. Following a primary infection, the virus relapses, and if the infection was in the genitals, then blisters will develop on a red base.
The virus can be transmitted with different types of sexual contact including vaginal, anal and orogenital contact. It is also transmitted by asymptomatic carriers, i.e., people who are infected and carry the virus but have not developed symptoms at the time of sexual contact.
This viral disease can also be transmitted by contact with lesions from other parts of the body, particularly the fingers, the eyes and the mouth.
Following primary infection, the virus is transported to the local nerve ganglia where it becomes latent (dormant) and can reactivate resulting in recurrent herpes infection. Triggering factors causing recurrent infection include weak immune system, stress, menstruation as well as other factors that lead to malaise.
The clinical picture of recurrent genital herpes infection is characterized by the occurrence of painful blisters in clusters on an erythematosus (red) base. The blisters then rupture leading to eschar (crust) and ulcer (erosions) formation. These completely resolve in 1‑2 weeks without scarring.
In men, genital herpes infects the glans penis, the foreskin (prepuce), the shaft of the penis (body), the mons pubis (pudenda), as well as the anus and/or the thighs (buttocks).
In women the virus is found on the vulva, the vagina, the cervix, the pudenda, the thighs and the anus. Through the epidermis (skin), the virus resides in a latent state in the nerves establishing a lifelong infection. The virus can also be found at the oropharynx, but this occurs more rarely.
Today, there is no cure for genital herpes simplex virus. The patient must be aware of the recurrent episodes of the disease and its transmission during sexual contact. The use of condoms is deemed necessary, although it does not offer 100% protection.
The treatment of episodes and of primary infection is carried out with oral administration of antiviral drugs that control the symptoms and clinical manifestations of the disease, but cannot eradicate the virus. In order to be effective, treatment with these drugs should be initiated within 72 hours from the onset of blisters. Treatment of genital herpes is done with the use of specific drugs, called virostatic drugs. This means that they do not kill the virus, but stop it from multiplying. The virus cannot be eradicated, but it remains in the body through out our life; thus the aim of the treatment is to reduce the duration of each episode, to accelerate healing and indirectly to shorten the infectious period and reduce the number of recurrences or to completely stop them.
The most well know antiviral drugs are acyclovir (Zovirax), famciclovir (Famvir), valacyclovir (Valtrex) and brivudine (Brivir).
In cases of primary infection the drugs are administered for 10 days, while in recurrent episodes they are administered for 5 days. Moreover, an antibiotic topical cream is applied on the blisters for the prevention of possible cross-contamination.
Prophylactic suppressive treatment with the aforementioned drugs is recommended for patients who frequently experience episodes, (more than 6 per year). These drugs have to be administered for 6 continuous months in order to reduce viral outbreaks.