Genital herpes

Genital herpes or herpes genitalis is a viral infection that causes herpetic lesions (blisters) on the cervix, vagina and external genitalia. It is also called herpesvirus Type-2 infection. Genital herpes is a sexually transmitted disease but also may be transmitted asexually from wet surfaces or by self-transmission (touching a cold sore and then touching the genital area).

The initial infection is very painful and lasts about a week. The infection can re-occur. Some people have few or no recurrences whereas others may have frequent attacks. The recurrences are less painful and usually produce itching and burning. Symptoms may occur with sunburn, dental work, stress, or inadequate rest and food. Close human contact by mouth, oropharynx, mucosal surface, vagina and cervix seems necessary to acquire the infection. Other susceptible sites are skin lacerations and conjunctivae.

The infected area becomes red and swollen with severe itching and pain. It starts as a blister, which later coalesces, ulcerates and encrusts. In females, the labia is the primary site, although cervix, vagina and perineal skin may also be affected. In males, the glans penis, foreskin, or penile shaft are usually affected. Flu like symptoms may occur 3 or 4 days after the lesions appear. Inguinal lymph adenopathy (swelling of the lymph nodes in the groin), slight temperature elevation, myalgia (muscle aches) and dysuria (pain while urinating) are often noted.

In the female, a purulent discharge may develop from secondary bacterial infection. Pain is severe in the first week and then decreases. The lesions subside in about 2 weeks unless they become secondarily infected. Rarely, complications may arise from extragenital spread, such as to the buttocks, upper thighs, or even to the eyes as a result of touching lesions. Other potential problems are aseptic meningitis and severe emotional stress related to the diagnosis.

Herpes simplex virus type 2 (HSV-2) appears to be the cause of about 80% of genital and perineal lesions. This virus causing herpes genitalis is usually killed at room temperature by drying. Any stress can lead to an outbreak of this infection in a susceptible host. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk of fetal mortality and morbidity if this occurs. Hence, a cesarean section may be performed if the virus recurs near the time of delivery.

There is no cure for genital herpes, but treatment is aimed at relieving the symptoms. The goals of management are to relieve pain and discomfort, prevent the spread of infection, relieve anxiety, decrease the potential health risks, initiate counseling, and transfer knowledge to the affected person regarding treatment regimen, self care and implications for the future.

Acyclovir (Zovirax), an antiviral agent is the first drug of choice for the genital herpes. It is helpful in altering the course of infection by reducing the duration of infection and by preventing its recurrences. It is available for topical, oral and intravenous use.

Pain is relieved by keeping the lesion clean, and by following proper hygienic practices. Taking sitz bath will ease discomfort. Wearing clean, loose, soft, and absorbent clothing can increase comfort. Aspirin and other analgesics are effective in controlling pain. Avoid use of occlusive ointments and powders because they tend to prevent the lesions from drying.

Bed rest is encouraged for those who have considerable pain and malaise. Contact of urine with herpes lesions may cause pain which often makes the affected person reluctant to void. Voiding can be assisted by pouring warm water over the vulva or sitz bath. Taking more fluids and consciously voiding every 4 to 6 hours will prevent other complications.

Education about Genital herpes:
1. Woman can have children; The obstetrician should be informed if you are pregnant.
2. Lesions should be washed gently with soap and running water and lightly dried.
3. Avoid exposure to prolonged sunlight.
4. Obtain information from HELP (Herpectics Engaged in Living Productivity).
5. Precautions are unnecessary in the absence of active lesions.
6. For a partner with no history of genital herpes, a condom should be used.

The problems of genital herpes are both physical and psychological. Stress is relieved by counseling and proper explanation by the health care professionals. To prevent transmission, intercourse should be avoided until the lesions heals.