Herpes Genital (ICD-10: A60) 🚨

Genital Herpes: A Common Sexually Transmitted Viral Infection

Genital herpes is a widespread and chronic sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). There are two distinct types of the virus—HSV-1 and HSV-2—both of which can lead to infections in the genital area. While HSV-2 is traditionally more closely linked to genital lesions, HSV-1, which commonly causes cold sores on the lips, has increasingly been identified as a source of genital herpes due to changes in sexual behavior, particularly oral-genital contact.

The primary manifestation of genital herpes is a painful vesicular rash in the genital area, often accompanied by inflammation, discomfort during urination, and flu-like systemic symptoms. The condition is characterized by episodes of active outbreaks (during which symptoms are present and viral shedding occurs) and periods of dormancy, when the virus remains latent in the body without producing visible symptoms.

How Genital Herpes Is Transmitted

The herpes simplex virus is highly contagious and spreads through direct skin-to-skin contact, especially during sexual activity. The most common modes of transmission include:

• Unprotected vaginal, anal, or oral sex with an infected partner;
• Contact with infected skin or mucous membranes (even in the absence of visible symptoms);
• Sharing of contaminated personal hygiene items (e.g., towels, underwear), although this is rare;
• Transmission from mother to newborn during childbirth if the mother has an active genital herpes outbreak.

Importantly, herpes can be transmitted even when no symptoms are visible. This phenomenon, known as asymptomatic viral shedding, makes it difficult to prevent transmission without knowledge of one’s infection status. As a result, many individuals carry the virus unknowingly and may transmit it to sexual partners.

Persistence and Recurrence

Once a person is infected, the herpes virus remains in the body for life. After the initial infection (primary episode), HSV enters a dormant state in the nerve ganglia near the base of the spine. Reactivation of the virus can occur at any time, typically during periods of stress, immune suppression, illness, or hormonal changes.

Recurrent episodes of genital herpes vary in frequency and severity from person to person. While some individuals may have multiple flare-ups per year, others may experience rare or no recurrences. Recognizing the early warning signs—such as tingling, itching, or localized burning—can help initiate timely treatment and reduce the duration and severity of symptoms.

Symptoms: How Genital Herpes Manifests

Not all individuals infected with the herpes simplex virus exhibit immediate or recognizable symptoms. In fact, many people are unaware they carry the virus until the first outbreak occurs—which may happen 2 to 12 days after exposure, or in some cases months or even years later.

When symptoms do appear, they may include:

• Painful vesicular rash in the genital, perianal, or inner thigh area;
• Red patches or clusters of small blisters that break open and develop into shallow ulcers;
• Burning, tingling, or itching in the affected region prior to rash onset (prodromal stage);
• Genital discomfort: Pain during urination, vaginal discharge, inflammation of the labia or glans penis;
• Systemic symptoms: Fever, malaise, muscle aches, headache, and swollen lymph nodes in the groin (particularly in primary infection);
• Ulcers in the mouth, urethra, or rectum: Less common, but possible in severe or recurrent cases.

The first outbreak, or primary episode, tends to be the most intense, lasting up to two to four weeks. Recurrent episodes are typically shorter and milder, although still painful and emotionally distressing for many individuals.

Diagnosis: Confirming the Infection

Clinical diagnosis of genital herpes is often based on visual examination of lesions and medical history. However, confirmation through laboratory testing is recommended to differentiate HSV from other genital ulcer diseases, especially in atypical cases.

Diagnostic methods include:

• Viral culture: Swabbing a fresh blister to isolate and identify the herpes virus (more reliable during early lesions).
• Polymerase chain reaction (PCR): Detects HSV DNA with high sensitivity, and can distinguish between HSV-1 and HSV-2.
• Type-specific serologic testing: Blood tests that detect HSV antibodies, useful for diagnosing asymptomatic infections or determining prior exposure.

A consultation with a dermatologist or venereologist is strongly advised when symptoms suggest herpes, particularly during the initial episode or in cases with frequent recurrences.

Treatment: Managing Symptoms and Preventing Recurrence

There is currently no cure for genital herpes. However, medical management aims to reduce symptom duration, alleviate discomfort, minimize recurrence, and decrease viral transmission to sexual partners.

Mild or Asymptomatic Cases:

• General hygiene: Daily gentle cleansing of the genital area, using warm water and mild soap;
• Loose cotton underwear and clothing: Reduces friction and irritation of lesions;
• NSAIDs (e.g., ibuprofen, paracetamol): To manage pain, inflammation, and fever;
• Warm sitz baths: Help soothe discomfort and promote healing of ulcers.

Moderate to Severe Cases or Frequent Recurrences:

• Antiviral medications: Acyclovir, valacyclovir, or famciclovir—prescribed for 5–10 days during acute outbreaks, or daily as suppressive therapy in recurrent cases;
• Early initiation: Antivirals are most effective when started at the first sign of recurrence;
• Preventive therapy: Long-term daily antiviral use reduces outbreak frequency and lowers the risk of transmission to partners.

Preventing Transmission to Sexual Partners

Reducing the spread of genital herpes to partners involves consistent preventive behavior and open communication. Key recommendations include:

• Disclose infection status: Inform sexual partners about your diagnosis, even during asymptomatic periods;
• Avoid sexual contact during outbreaks: Virus shedding is highest when lesions are present;
• Use condoms consistently: Condoms reduce, but do not eliminate, the risk of transmission (the virus can affect skin not covered by the condom);
• Antiviral suppression: Daily medication can significantly reduce viral shedding and transmission risk;
• Regular STI testing: Especially for both partners if in a non-monogamous or new relationship.

Preventing Recurrence of Genital Herpes

Identifying and managing personal trigger factors can help reduce the frequency and severity of outbreaks. Keeping a symptom diary is helpful in recognizing patterns and developing an individualized prevention plan.

Common triggers include:

• Physical illness (e.g., influenza, fever);
• Other infections (viral or bacterial);
• Chronic fatigue or sleep deprivation;
• Prolonged emotional stress or anxiety;
• Hormonal fluctuations (e.g., menstruation);
• Skin trauma, including friction during intercourse;
• Immunosuppressive therapies or conditions affecting the immune system.

To strengthen the immune response and reduce recurrence:

• Maintain a balanced diet rich in vitamins and minerals;
• Stay hydrated and engage in regular physical activity;
• Prioritize rest and mental health support;
• Discuss the possibility of long-term suppressive antiviral therapy with your physician.

General Risk Reduction and Self-Care

Although genital herpes cannot be completely cured, individuals with the virus can live healthy and fulfilling lives. Risk reduction strategies help protect others and maintain skin health during active and dormant phases.

• Avoid touching active lesions: And wash hands thoroughly if contact occurs;
• Refrain from sexual activity during symptomatic episodes;
• Practice proper hygiene: Avoid shared towels or intimate hygiene products;
• Limit alcohol and tobacco use: Both can weaken immune response;
• Stay informed: Regularly consult with your healthcare provider for updated guidance and testing options.

With early diagnosis, informed care, and preventive action, genital herpes can be effectively managed, and the risk of complications and transmission greatly reduced.