Genital herpes is caused by HSV (Herpes Simplex Virus); It is a viral disease classified as a sexually transmitted disease that spreads through contact with the mucous membranes in the mouth, vagina or genital area. Genital herpes is an infection that affects the genital areas (penis in men, vulva and vagina in women) and the area around it (buttocks and anus).
Causes of genital herpes?
Two types of Herpes Simplex Virus cause genital lesions: HSV-1 and HSV-2
HSV-1 often causes blisters in the mouth area, while HSV-2 causes lesions around the genital sores or anus. The emergence of herpes is closely related to the immune system. The disease is more frequent and prolonged in women with weakened immune systems (due to stress, infection or medications).
·Herpes simplex virus type-1 (HSV-1)This virus is mostly on the lips, It occurs as an infection in the mouth and face. It is the most common form of herpes simplex and many people have it since childhood. HSV-1 often causes sores, blisters in the mouth, or infection of the eyes (especially the conjunctiva and cornea). It can also lead to infection of the brain (meningoencephalitis). It is transmitted through contact with infected saliva. In adult life, 30-90% of people develop antibodies. It is more common in societies with low socioeconomic levels.
·Herpes simplex virus type-2 (HSV-2)This virus is usually transmitted through sexual intercourse. Symptoms are ulcers and wounds in the genital area. However, some people with HSV-2 may not have symptoms. It may cause Type 1 and Type 2 cross-infection through oral-genital area contact. In other words, you can get genital herpes from your mouth and oral herpes from your genital area.
Genital herpes spreads only from person to person through direct contact. It is believed that 60% of sexually active adults have the disease
HOW OFTEN IS GENITAL HERPES?
CDC estimates that 776 thousand people in America get a new herpes infection every year. Genital herpes is extremely common in the USA, with 16% nationwide of people ages 14-49 having genital HSV-2.
What are the symptoms of genital herpes?
Herpes symptoms are similar in men and women. When exposed to the virus, before lesions develop, usually There is an incubation period lasting 3-7 days. During this time, there are no symptoms and the virus does not spread to other people. The first infection usually occurs within 2 weeks, and symptoms appear as skin redness followed by itching and tingling sensations. Eventually a blister (vesicle) appears. When the blisters burst, they usually turn into ulcers that are very painful to touch within 7-15 days. The infection is absolutely contagious from the day the itching begins until the ulcer is completely healed, which usually takes 2-4 weeks. However, infected individuals can transmit the virus to their sexual partners even if there are no visible symptoms of the disease.
In most patients, inflammation of the cervix (cervicitis) may be observed, and in some women, cervicitis may even be the only symptom of herpes.
In some patients with genital herpes. Women may complain of painful urination, which may be the cause of inflammation of the urethra (urethritis).
Symptoms vary depending on whether the infection is experienced for the "first time" or "recurrent". Symptoms of a primary infection are usually worse for the first time. However, new HSV infection may be asymptomatic in most cases. Studies have shown that 10-25% of people infected with HSV-2 are unaware that they have genital herpes. Even infected people with mild or no symptoms can transmit the herpes virus.
Primary Genital Herpes:The first symptoms usually appear in or around the genital area 1-2 weeks after sexual intercourse. There is a tingling or stinging sensation in the affected areas (genitals, buttocks or inner legs), and blisters appear in groups of small rashes. After 2-3 weeks, the blisters multiply and burst, turning into painful open sores. After a while, the lesions dry out, crust over, and heal quickly without leaving any scars. Blisters in moist areas heal slower. Lesions may itch, but scratching reduces healing.
Other symptoms of genital herpes (flu-like discomfort, headache, muscle pain, fever, and swollen glands in the groin area and neck) may be observed in 40% of men and 70% of women. . Some patients experience difficulty urinating and vaginal discharge. It is suggested
Recurrent Genital Herpes:Generally, recurrent lesions have a milder course and are of much shorter duration (primary infection lasts 3 weeks, recurrent infection lasts 3 days). Women may experience only mild itching, while it is much milder in men. On average, a person experiences 4 relapses in 1 year. Over time, the frequency of recurrence decreases.
How is Herpes Diagnosed?
Herpes simplex virus is generally recognized by its characteristic lesions: Thin-walled, water-filled on red skin. It is in the form of bubbles. However, many other diseases can resemble herpes, and the doctor may not rely solely on visual assessment as a basis for diagnosing herpes. Additionally, some patients carrying the virus may have no visible lesions. Laboratory tests are necessary to confirm the diagnosis of herpes. These tests:
·Virological tests (taking a viral culture from the lesion)
·Serological tests (blood test for antibody detection)
Centers for Disease Control (CDC) recommends both tests in diagnosing genital herpes. However, other sexually transmitted diseases should also be screened for in patients diagnosed with genital herpes.
When the first signs of the disease appear, a fluid sample taken from the blisters can be sent to the laboratory for culture. However, culture is positive in only 50% of infected patients. On the other hand, being negative does not mean that there is no virus. However, a positive response is highly reliable when a sample is taken from the fluid-filled blister at an early stage before it dries or crusts.
VIROLOGICAL TESTS
Viral tests, fluid sample from the lesion. or by taking culture. It is done in the early period, ideally within the first 3 days after it becomes visible. If there is a virus, it will grow in this liquid within 1-10 days. If the infection is severe, this growth occurs within 24 hours. The viral culture test gives a very accurate response if the lesions are in the clear, fluid-filled blister stage (vesicle), but the test does not work properly if the lesions are old ulcers or recurrent lesions.
Polymerase chain reaction (PCR) testsare much more accurate than viral cultures, and the CDC says this test is used to look for herpes in spinal fluid in the diagnosis of herpes encephalitis. recommends its use. PCR can make a diagnosis by copying the virus DNA, even if a very small amount of DNA is present in the sample. PCR is much more expensive than viral culture and the FDA has not approved it for use on genital specimens. However, since PCR is extremely sensitive, many laboratories use this test in the diagnosis of herpes.
Tzanck smear testis an old type virological test, it is used by scraping the herpes lesion and examined under a microscope. Multinucleated giant cells or particles carrying the virus (inclusion body) are specific findings. It is a quick test but is only 50-70% accurate. This test cannot distinguish between Herpes simplex or Herpes Zoster. The Tzanck test is not reliable in the definitive diagnosis of herpes infection and is not recommended by the CDC.
SEROLOGICAL TESTS
Serologic (blood) tests are specific to the virus and the type of virus (HSV-1). and HSV-2) identifies antibodies. When someone is infected with the herpes virus, that person's body's immune system produces special antibodies to fight the infection. If the blood test detects antibodies to Herpes, this is proof that you have been infected with the virus, even if the virus is in a latent (non-active) phase. This means that you carry the virus and can infect others.
There are 2 different proteins associated with the herpes virus.
·Glycoprotein gG-1 (HSV-1)
· Glycoprotein gG-2 (HSV-2)
Glycoprotein (gG) type-specific tests have been used since 1999. CDC recommends type-specific glycoprotein (gG) tests in the diagnosis of herpes.
Serological tests are most accurate when administered 12-16 weeks after exposure to the virus.
Recommended Tests:
·HerpeSelect: It includes two tests:ELISA (enzyme-linked immunosorbent assay) orImmunoblot test. These two tests are very accurate in detecting both types of Herpes Simplex Virus. However, since the samples need to be sent to the laboratory, results take longer than office type Biokit tests.
·Biokit HSV-2 (SureVue HSV-2): This test only detects HSV-2. It does. Its main advantage is that it only requires pricking the fingertip and results are achieved in less than 10 minutes. It is an extremely accurate and inexpensive test.
·Western Blot Test: It is the gold standard for researchers as its accuracy is 99%. However, since it is expensive and time-consuming, its use is not common compared to other tests.
When tests are performed in the early stage of the infection, the results may be inaccurate, and your doctor may recommend repeating the test.
In the following cases, your doctor may specifically request serological tests:
·For people with negative herpes viral culture tests but recurrent lesions
·To confirm disease in people with visible symptoms of genital herpes
·If your partner has visible genital herpes or has been diagnosed with genital herpes
·Those who have multiple partners or when there is a need to be investigated for sexually transmitted diseases
How is genital herpes treated?
Genital herpes treatment varies depending on whether the infection is experienced for the first time (primary infection) or whether the symptoms of a previous infection appear again (recurrent infection).
Antiviral drugs including aciclovir, famciclovir and valaciclovir can be used in the treatment of genital herpes. These are available on the market under different names. But these medications cannot completely eliminate the virus from your body. If antivial treatment is started at the early stage when symptoms appear, it reduces the severity and duration of symptoms. Acyclovir is the oldest antiviral drug and must be taken 5 times a day. Famciclovir and valacyclovir are new antiviral drugs and are taken 3 times a day.
HSV recurs in 2/3 of people with Genital Herpes, and in 1/3, it recurs 3 or more times each year. HSV can never be completely eliminated from the body, but it can lie dormant for a while and then become active again and cause symptoms.
Primary Infection
If this is your first time experiencing genital herpes, see your gynecologist. . He may need to prescribe some antiviral tablets (such as acyclovir) to be used 5 times a day.
Acyclovir works by preventing HSV from multiplying. However, this medication cannot completely clear HSV from your body and will not work if you stop taking your medication.
If you start treatment but still have new blisters and open sores in your genital area
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