Genital herpes was the sexually transmitted disease which bothered patients until HIV appeared on the scene. No, this was no deadly disease like the latter. Yet, it caused tremendous anxiety among patients. The reason was the frequency of recurrent attack which this virus produced. Genital herpes or herpes progenitalis, as it is medically termed, is caused   by a virus. This virus is transmitted following sexual intercourse with an infected person. The virus enters the skin and travels to the nearest nerve root.

Symptom and Signs

After a few weeks of entry of the herpes virus, the patient notices smalll eruptions on the genitals. Gradually they get filled with fluid and may rupture spontaneously. Pin-head sized raw areas are a common feature in these patients. The patient may have a burning sensation while passing urine. Fever, joint pains and painful swellings (glands) in the groin are also seen during the first attack. This is termed ‘primary infection’ and could last for 10-20 days. If the patient does not seek medical attention the eruptions can get infected by bacteria resulting in pus formation. n women, the primary attack may be extremely painful making even walking difficult. Women suffer from a lot of discomfort and complain of difficulty in passing urine.

Recurrent Attacks
 
A recurrence of genital herpes is the rule rather than an exception. After the primary infection subsides, the virus returns to the nerve root till it gets activated again at a later date. The number of recurrent episodes is unpredictable. Some unfortunate young men and women get multiple attacks every month whereas others get few attacks in a year. Fortunately, recurrences are less painful to the patient. In fact, some patients hardly realise it unless they closely observe their genitals. One or two eruptions may appear, get eroded and disappear within a couple of days. Usually there is no fever of gland swellings during recurrent attacks of herpes.

Diagnosis

This condition is usually diagnosed by the patient’s symptoms and signs. There is no need to undertake any tests. Certain specialised and expensive blood tests are available which are carried out only for research purposes or when there is a doubt about the diagnosis.

Treatment

Genital herpes is a viral infection like chicken pox and measles. All these conditions clear within a certain period. However unlike other viral infections, recurrences are the major cause of anxiety in genital herpes. Acyclovir, Valacyclovir and Famciclovir  are antiviral drugs used in the treatment of genital herpes. The dose varies depending on whether the infection is primary or recurrent. Unfortunately the cost of therapy is very high and treatment is not a guarantee against recurrences. Therefore most venereologists prefer acyclovir cream which is relatively inexpensive. Treatment only ensures rapid healing of the eruptions and decreases the chances of viral shedding.

Partner at risk

Patients are always advised to avoid intercourse during the acute episode – both in primary and recurrent stage. If this is not possible a condom should be used. Intimate contact when the eruptions are present puts the partner at risk of getting the disease. Moreover if both the partners are infected it causes a lot of anxiety as they alternately develop recurrences of herpes. This eventually destroys their sex life and may even cause maritall discord.

Pregnancy and herpes

If the wife gets infected with genital herpes during pregnancy she must inform her gynaecologist. The lady should return to her doctor for regular check-up during the last stage of pregnancy so that the doctor can decide if she is fit to undertake normal delivery. At the time of delivery if eruptions are present, doctors recommend caesarean section so as to ensure safety of the newborn.

Other ‘herpes’

Sometimes patients developing blisters near the mouth appear to be shocked when they learn that the doctor has diagnosed them as ‘Herpes’. They wonder how they have contracted this sexually transmitted disease. The fact is that this is another type of infection caused by a virus belonging to the same group. Blisters on the face are usually caused by Herpes simplex, “type 1” virus and is known as Herpes labials. This infection also has recurrences similar to genital herpes and it usually follows an episode of fever or some serious illness. There is yet another condition, Herpes Zoster, in which painful blisters appear on one side of the body. This is caused by the same virus which causes chicken pox and usually there are no recurrences as in the other types of herpes.

Dr. Rajan T.D., MD, DVD, DNB. Specialist in Skin & Sexually Transmitted Diseases Doctors’ Centre, 102B Samrock Apts., ,
Andheri West, Mumbai-400058, India.
Tel: 0091-22-66982747
Email: rajan.td@gmail.com