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Genital Herpes

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What is Genital Herpes?

Genital herpes is a common sexually transmitted disease (STD) due to transmission of the Herpes Simplex Virus (HSV) during any type of sexual activity. Herpetic infections can have no symptoms or present as painful blisters or ulcers around the genitals, rectum or mouth. Genital herpes is problematic because carriers are often asymptomatic and spread the virus unknowingly. The virus also has the ability to remain dormant and reactivate in hosts.

While it’s true there is no cure for herpes, safe sex can help prevent infection and medications can help reduce symptoms.

Cause and Transmission

Genital herpes is caused by the herpes simplex virus (HSV). There are two forms of the virus: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2).  While HSV-1 usually causes oral herpes and HSV-2 primarily causes genital herpes, both viruses can produce either oral and/or genital forms of herpes.

The HSV virus is often spread through non-sexual contact with contaminated saliva or through oral sex.

Genital herpes is spread through:

  • Vaginal, anal and/or oral sex with an infected individual
  • Direct contact with a herpes blister/sore
  • Direct contact with contaminated genital secretions (semen, mucus, vaginal secretions, rectal secretions)
  • Direct skin-to-skin contact (oral or genital area) of someone with the infection

Herpes cannot be transmitted from:

  • Toilets
  • Swimming pools
  • Touching someone with herpes’ belongings

Signs and symptoms

Usually herpes infection doesn’t have any symptoms, which is why it can be difficult to know if you have herpes. If herpes does produce symptoms, it most often causes painful blisters when first infected which usually reappear later. Symptomatic herpes is often more severe in women than in men.

Common symptoms include:

  • Blisters around the genital area including anus and thighs which can break and leaves sores
  • Painful or itchy genitals
  • Headache
  • Fever
  • Feeling generally unwell
  • Muscle aches
  • Pain or difficulty urinating
  • Swollen lymph nodes

Complications

Recurrence

After initial infection the herpes virus remains inactive in the nervous system of the host, without producing symptoms. Later the virus can reactivate in response to stress or other triggers. Reactivation of the virus causes symptoms, usually blisters and pain, and is commonly called a flare.

Additional infections and STIs

As the herpes virus can cause blisters that break, bacteria or fungi can infect the sores left by blisters causing infections. The risk of being infected with other sexually transmitted infections, including HIV, also increases with the presence of genital sores.

Neonatal Herpes

Pregnant women with herpes can transmit the herpes virus to the baby, commonly during the birthing process. Herpes infections in babies can be fatal but are preventable with antiviral medications. Talk to your doctor if you are pregnant and you think you may have herpes.

Testing

It is important to get regularly tested for STDs if you are sexually active, especially if you have multiple sex partners. Herpes testing is not part of the usual STDs tested for, however consider and ask for a herpes test especially if you are symptomatic, or if you have had sexual contact with someone with herpes.

Testing can involve:

  • Swabbing the ulcer/blister to test for the presence of the virus (more accurate)
  • Blood test to assess antibodies against the virus

You can get tested for genital herpes as well as other STDs for free in Puskemas and public hospitals (expect a long wait though), various private hospitals or private clinics and laboratories (Angsamerah, Bio Medika, Prodia, Global Doctor, International SOS). Prices for herpes tests can range from around Rp. 300,000 - Rp. 800,000.

Treatment Options

Unfortunately there is no cure for herpes, however it is a manageable lifelong disease. Herpes  flares usually resolve on their own. However symptoms of flares can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), wound care, and analgesics for pain management.

If you are experiencing frequent and painful flares of herpes, daily antiviral medications can be helpful to reduce the number and severity of flares and reduce the risk of transmission to others. Talk to your doctor about your herpes symptoms!

Prevention

Practicing safe sex is key to avoiding genital herpes. Some tips for safe sex with or without herpes:

  • If you think you may have herpes, get tested
  • If you know you have herpes, tell your partner
  • Use a condom correctly and consistently to reduce the risk of transmission of herpes and other STDs. 
  • Avoid having vaginal, anal, oral sex, sharing toothbrushes, razors, drinks if you are symptomatic with fevers, blisters or open sores. This is the time when the virus is most likely transmitted to others

References

Albrecht, M. (2018). Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection. Retrieved from https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-genital-herpes-simplex-virus-infection/abstract/61

Ayoade, F., & Todd IV, J. (2018). Herpes Simplex: Background, Microbiology, Pathophysiology. Retrieved from https://emedicine.medscape.com/article/218580-overview

Bernstein, D., Bellamy, A., Hook, E., Levin, M., Wald, A., & Ewell, M. et al. (2012). Epidemiology, Clinical Presentation, and Antibody Response to Primary Infection With Herpes Simplex Virus Type 1 and Type 2 in Young Women. Clinical Infectious Diseases, 56(3), 344-351. doi: 10.1093/cid/cis891

Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med 1997;337:509-15. PMID:9262493 doi:10.1056/NEJM199708213370801

Douglas, J., Critchlow, C., Benedetti, J., Mertz, G., Connor, J., & Hintz, M. et al. (1984). A Double-Blind Study of Oral Acyclovir for Suppression of Recurrences of Genital Herpes Simplex Virus Infection. New England Journal Of Medicine, 310(24), 1551-1556. doi: 10.1056/nejm198406143102402

Fleming, D., McQuillan, G., Johnson, R., Nahmias, A., Aral, S., Lee, F., & St. Louis, M. (1997). Herpes Simplex Virus Type 2 in the United States, 1976 to 1994. The New England Journal Of Medicine, 337(16), 1105-1111.

Gnann, J., & Whitley, R. (2016). Genital Herpes. New England Journal Of Medicine, 375(7), 666-674. doi: 10.1056/nejmcp1603178

Herpes simplex virus. (2017). Retrieved from https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

Looker, K., Garnett, G., & Schmid, G. (2008). An estimate of the global prevalence and incidence of herpes simplex virus type 2 infection. Bulletin Of The World Health Organization, 86(10), 805-812. doi: 10.2471/blt.07.046128

Martin, E., Krantz, E., Gottlieb, S., Magaret, A., Langenberg, A., & Stanberry, L. et al. (2009). A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition. Archives Of Internal Medicine, 169(13), 1233. doi: 10.1001/archinternmed.2009.177

STD Facts - Genital Herpes. (2017). Retrieved from https://www.cdc.gov/std/herpes/stdfact-herpes.htm

Wald, A., & Link, K. (2002). Risk of Human Immunodeficiency Virus Infection in Herpes Simplex Virus Type 2–Seropositive Persons: A Meta‐analysis. The Journal Of Infectious Diseases, 185(1), 45-52. doi: 10.1086/338231