What is genital herpes?

Page Content

• How is genital herpes transmitted?
• What is primary genital herpes?
• What is recurrent genital herpes?
• How to treat genital herpes?
• Is there a vaccine against the herpes simplex virus?
• Genital herpes and childbirth planning

Genital herpes is one of the most common sexually transmitted infections. It is caused by herpes simplex virus type 2 (HSV-2) or HSV, but more often by herpes simplex virus type 1 (HSV-1). These two pathogens are encapsulated DNA viruses, sensitive to disinfectants and environmental factors. Due to the high genetic similarity between HSV-1 and HSV-2, there are many biological similarities and cross-reactive antigenic responses between the viruses.

How is genital herpes transmitted?

The main mode of transmission of HSV-1 and HSV-2 is direct contact. Primary infection with herpes simplex virus 1 most often occurs during childhood, after maternal antibody decline during the first year of life. From age 40 onwards, it is estimated that infection with HSV-1 is ≥ 85-90% in the general population.

HSV-2 is also primarily transmitted sexually; the infection rate increases only after puberty. Many studies have shown a higher infection rate with HSV-2 in women than in men. A possible explanation is that men are more often affected by asymptomatic genital HSV-2 infections, which leads to higher transmission rates from men to women.

Individuals with clinical signs of genital herpes, as well as those with asymptomatic herpes simplex virus infection, can transmit the virus to their sexual partners.

Due to its low environmental resistance, herpes simplex virus can remain infectious only for a few days on moist surfaces. Therefore, if proper hygiene (including personal hygiene) is maintained, transmission routes other than sexual contact do not play a significant role.

What is primary genital herpes?

Primary genital infections caused by HSV-1 and HSV-2 are generally asymptomatic.

Classical clinical signs are papular (vesicular) or macular lesions of the skin and mucous membranes, appearing about 3 to 7 days after sexual contact; they evolve into vesicles, pustules, and ulcers, which can last up to 3 weeks.

Typical symptoms also include pain, particularly painful inflammation of the vulva in women, burning sensations, and tingling.

Relatively common associated symptoms include lymphadenopathy (enlargement of regional lymph nodes), increased body temperature, cervicitis (in women), and proctitis (in men).

What is recurrent genital herpes?

After primary infection, the virus remains a lifetime in sensory nerve ganglia, mainly affecting sacral ganglia in genital infections. From there, the virus can reactivate, causing recurrences of the infection.

Many physiological and environmental factors, such as fever, excessive exposure to ultraviolet rays, menstruation, intense stress or trauma, and air travel, can trigger an exacerbation of genital herpes.

Recurrences almost always manifest initially with symptoms such as neurological manifestations, dysesthesia (various pathological sensations such as pain, itching, tingling) or lumbosacral pain 1 to 2 days before the appearance of skin and mucous membrane lesions. Frequent recurrences of genital herpes particularly affect young women experiencing high levels of stress in their family and professional life.

How to treat genital herpes?

Most individuals experiencing their first episode of genital herpes can be treated orally with antiviral medications.

Intravenous routes are generally prescribed for complicated infections (e.g., central nervous system lesions and disseminated diseases).

Topical treatment is administered in the form of creams or ointments containing antiviral components.

The 2021 recommendations from the U.S. Centers for Disease Control and Prevention suggest one of the following oral treatments:

• Acyclovir
• Famciclovir
• Valacyclovir

Is there a vaccine against herpes simplex virus?

To date, there is no licensed vaccine against genital herpes, although research has been ongoing for several decades. "Therapeutic" vaccines differ from "preventive" vaccines by their mode of action. While therapeutic vaccines aim to prevent recurrent infections by herpes simplex virus and asymptomatic transmission in individuals with latent infection, preventive vaccines are designed to prevent primary infection and subsequent latency of the virus.

Genital herpes is often underestimated, not only by patients but also by healthcare professionals, due to the variability and diversity of clinical manifestations. However, early screening and treatment significantly improve quality of life.

Genital herpes and childbirth planning

Pregnancy planning in the presence of genital herpes requires special attention. The virus can impact conception and fetal development, especially if primary infection occurs during pregnancy. If a woman is infected for the first time during pregnancy, the risk of transmitting the infection to the fetus increases considerably, which can lead to complications such as miscarriage or intrauterine infection.

In the chronic form of the disease, chances of conception are higher, but recurrences can reduce pregnancy possibilities due to inflammatory changes and discomfort during sexual intercourse. In such cases, it is important to follow a preventive antiviral treatment prescribed by a doctor.

Men carrying herpes simplex virus also risk transmitting the infection to their partner, which can complicate conception. Therefore, when planning pregnancy, both partners are advised to undergo examination, discuss preventive measures with their doctor, and choose the optimal time for conception.

Modern assisted reproduction techniques, including IVF, can be used for couples where one or both partners are HSV carriers. With proper medical monitoring and viral load control, the chances of successful pregnancy and carrying it to term significantly increase.