a. Overview and facts
Genital Herpes is a viral disease caused by Herpes Simplex Virus (HSV). HSV has further two types HSV-1 and HSV-2. Generally HSV-1 causes oral herpes while HSV-2 causes genital herpes. According to CDC, every 1 of 5 teenagers and adults suffers from HSV. There were over 500,000 cases of HSV reported in United States last year. Usually HSV-1 causes oral herpes which we all have normally seen if not suffered from, while HSV-2 is normally associated with genital herpes. In women, the genital areas most commonly affected are the vulva and the entrance to the vagina. Sores can also sometimes develop on the cervix. In men, sores are most common on the glans (end of the penis), the foreskin and shaft of the penis. Sometimes sores can develop on the testicles. Less commonly, both men and woman can experience sores around the anus, on the buttocks and tops of the thighs. Once affected form HSV, a person can have recurrence of the condition, triggered by certain physical and psychological causes.
b. Symptoms
Genital herpes could be completely asymptomatic but in the symptomatic cases it would have the following symptoms:
• Small red bumps, vesicles or ulcers (open sores) which might be present on either genitals, anus, thighs or surrounding areas.
• Itching at the site of infection
• Pain
• Burning at the affected area
• Feeling of abdominal fullness
• Desire to urinate frequently
• Vaginal discharge
• Painful urination
• Fever
• Headache and muscle aches
• Swollen lymph nodes in groin
c. Causes
Initial episode:
As afore mentioned, genital herpes is a sexually transmitted disease which is caused by Herpes Simplex Virus. Though, primarily HSV-2 is responsible for genital herpes but there is growing increase in HSV-1 affected genital herpes due to oral-genital contact. Genital herpes spreads from an affected person to another by vaginal, anal or oral sex. Up to 60% of HSV affected people, there are no symptoms but they are capable of transmitting disease to another person. The initial episode may take 2-12 days to develop after the contact.
Recurrence of the condition:
Recurrence takes place when virus replicates in nerve ganglia. Then the virus moves towards the primary site of infection through nerves. This whole process is triggered by certain physical and psychological factors including:
Physical factors:
• Any other genital infection
• Menstruation
• Alcoholism
• Sun exposure of the infected site
• Friction or damage of the primary site
• Associated systemic condition causing immunodeficiency
Psychological factors:
• Prolonged stress
• Anxiety attacks
• Bipolar disorder
d. Diagnosis
Genital Herpes could surpass without even being diagnosed as it might be asymptomatic in some cases. Best diagnosis could be made when there is initial outburst of the disease. Physical examination, medical history and the culture tests can affirm the presence of the disease. Though a blood test can also show the presence of HSV antibodies but it is best to get the fluids tested from the sores to check the presence of HSV.
e. Treatment & care
There is no permanent cure for the condition. Ideally antiviral therapy is given to shorten the duration of a genital herpes outbreak and speed healing. It also helps in reduction of the number of outbreaks suffered or can even prevent them completely. The preferred antiviral drugs are Valaciclovir, Aciclovir, and Famciclovir. Use of antiviral may not eliminate the virus from the body but they are helpful in reducing the duration and intensity of the outbreak of the condition. Valaciclovir can be also used as 'suppressive' treatment. Clinical trials have proved Valaciclovir to prevent or delay up to 85% of herpes outbreaks.
Along with the antiviral treatment, analgesics are also prescribed to reduce the pain. Many of the patients use over the counter painkillers for the relief of pain. A few patients have shown positive response towards topical anesthetic application as well, which helps in reducing the pain, itching and burning by the help of anesthetizing the area for some time.
f. Home remedies & lifestyle:
• Salt baths, used to wash the genital area, can clean, soothe and dry the sores. Use 1 teaspoon of salt in 600 ml of water or a handful in a shallow bath.
• Boric Acid powder diluted in water can be very helpful in soothing the sores. Fill bath tub with warm water and add 3-5 tbsp of boric acid in it and sit for 15-20 minutes in it. Then dry the body with soft, dry cotton cloth.
• Wear loose cotton underclothes as they can help minimize discomfort and allow healing.
• Some people have found that placing used cold tea-bags against the sores is soothing.
• When having active sores/condition avoid having sex or intimate physical contact with another person.
• Avoid touching the sores. If touched, wash hands immediately with antiseptic soap.
• An ice pack (ice wrapped in a tea towel) placed over the sores for 5-10 minutes may be soothing. Do not put ice directly onto skin as this may cause an 'ice burn'.
• Keep the sores dry and clean. Do not keep them moist. If needed you can use hair dryer on cool setting to dry after bathing or washing.
g. Complications
• Recurrence can at times be more painful than the initial episode.
• Though rare, but in some cases a mother can pass HSV to the child during labor.
• HIV susceptibility in increased in some cases.
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