How the virus behaves
Genital herpes is most often caused by the herpes simplex virus type 2, but increasingly also by type 1 virus - the same one that usually causes rashes on the lips during oral contact.
After the initial infection, the virus travels along nerve fibers to the nerve ganglia, where it enters a dormant state. Periodically, it is reactivated, descends back along the nerve and causes rashes on the skin and mucous membranes. That is why exacerbations always occur in approximately the same place.
It is important to understand: between exacerbations, the virus can be shed without visible rashes - this is called asymptomatic shedding. This is exactly how transmission to a partner most often occurs, and not at all at the height of an exacerbation, when a person usually avoids contact.
Symptoms
- The initial episode is usually the most severe: multiple painful blisters that rupture to form ulcers
- Severe pain, burning, itching
- Swelling and redness of the affected area
- Fever, weakness, body aches, headache
- Enlarged, painful inguinal lymph nodes
- Painful urination, sometimes to the point of urinary retention
- Discharge from the urethra or vagina
- Relapses are easier and shorter, there are fewer rashes
- Prodromal sensations before an exacerbation: tingling, burning, itching, nagging pain along the nerve - several hours or days before the appearance of blisters
- In some people, the disease occurs without noticeable symptoms at all.
What causes exacerbations
- Hypothermia and overheating
- Colds and fever
- Stress and overwork
- Lack of sleep
- Menstruation
- Intense solar radiation
- Mechanical irritation and trauma
- Taking immunosuppressive drugs
- Surgical interventions
- Exacerbations of other chronic diseases
Diagnostics
- PCR with material from the contents of the vesicles or from the bottom of the ulcer is the most accurate method; performed in the first days of exacerbation
- Determining the type of virus - 1 or 2, has prognostic significance: type 2 herpes recurs more often
- IgG antibodies to HSV types 1 and 2 - show whether a person is infected at all, but are not suitable for diagnosing a current exacerbation
- IgM antibodies are uninformative and often misleading
- Screening for other STIs, including syphilis and HIV—genital ulcers require exclusion of syphilis
- Examination by a specialist
- Consultation with a gynecologist during pregnancy
An important practical point: an antibody test does not show the “activity” of the infection and is not a reason for treatment. Numerous courses of “anti-herpetic therapy” based on IgG alone are meaningless.
Treatment
- Antiviral drugs in tablets are the basis of treatment; most effective when started early
- Episodic therapy: a short course for each exacerbation, started at the first prodromal sensations
- Suppressive therapy: daily use of the drug for a long time with frequent exacerbations; reduces their number significantly and significantly reduces the risk of transmission to a partner
- Local remedies are an auxiliary role and have no independent significance
- Painkillers for severe pain
- Care for the affected area: clean, dry, loose underwear
- Drinking plenty of fluids when urinating painfully
- Treatment of the primary episode begins without waiting for test results if the picture is typical
- A special approach during pregnancy - antiviral therapy at the end of pregnancy and a decision on the method of delivery
How to protect your partner
- Complete abstinence from contact during an exacerbation, starting from prodromal sensations until complete healing
- Using a condom outside of exacerbations reduces the risk, but does not eliminate it completely
- Suppressive antiviral therapy in the infected partner has been shown to reduce the likelihood of transmission
- An open conversation with a partner is unpleasant, but necessary; knowledge allows the couple to make informed decisions
- Testing your partner for antibodies to understand the situation in the couple
- Special attention when planning pregnancy, especially if the partner is not infected
Herpes and pregnancy
- The greatest danger is posed by primary infection in the third trimester: the risk of transmission to a newborn is maximum
- With long-standing infection, the woman has antibodies that are passed on to the child and significantly reduce the risk
- Antiviral therapy in the last weeks of pregnancy reduces the likelihood of an exacerbation at the time of birth
- For active rashes at the time of delivery, a caesarean section is usually recommended.
- Neonatal herpes is a rare but very serious condition, so all measures are aimed at preventing it
- A woman without herpes whose partner is infected is advised to take special care in the third trimester
Where to get examined in Tashkent
To confirm the diagnosis, PCR from the lesion is needed in the first days of an exacerbation, and in case of frequent relapses, the selection of suppressive therapy.
In Tashkent, examination and treatment of genital herpes is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If exacerbations occur frequently, discuss suppressive therapy with your doctor: it really changes the quality of life and reduces the risk for your partner. And be sure to rule out syphilis - ulcers on the genitals require this in any case. Clinic contacts are below.
