A-Z about Genital Herpes

Herpes treatment, Herpes testing, its Diagnosis & Prevention

Vanakkam, Namaste, and Welcome to Dr. Shah’s Clinic for Male Infertility & Sexual Health. In this article, I am going to tell you everything under the sun about Herpes Treatment. We are also going to discuss Genital Herpes symptoms, diagnosis, and herpes cure and its management. As a practicing sexologist, I have seen numerous patients suffering from genital herpes due to an improper diagnosis or treatment.

So, first, let’s answer a few questions about this rather irritating disease.

What is Herpes?

Genital Herpes affects an estimated 400 million people every year. It is among the most common sexually transmitted disease. It is caused by the Herpes simplex virus (HSV). More importantly, the infection is lifelong and undergoes cycles of activation and deactivation in the body.

The HSV virus is basically a DNA virus, moreover, there are 2 types. These HSV 1 and HSV 2. Most importantly, HSV 1 was commonly associated with oral herpes and HSV 2 with genital herpes. However, now recent data suggests that HSV 1 causes as much genital herpes as HSV 2.

What is Oral Herpes?

In this paragraph, we are going to briefly discuss about oral herpes. Oral herpes presents with cold sores or lesions in and around the mouth. Most people do not have manifest symptoms and get infected mostly during childhood, from non-sexual salivary contact.

The link between genital herpes and oral herpes is that the HSV 1 virus can spread from mouth to genital via oral sex.

How does genital herpes spread?

Genital herpes spreads commonly via oral, vaginal and anal intercourse. To elaborate further, common methods of spread include

  1. Contact with herpes sore
  2. Saliva from kissing a person with an oral sore or contact with genital sore

Furthermore, contact with an infected partner can cause herpes even if there are no visible sores. Consequently, most of the time, the individual may not even know that he/she is carrying the herpes infection.

Herpes Risk Factors

To elaborate further, genital herpes has specific risk factors. On an average 1 in 6 men seem to have herpes in the USA, furthermore to make things worse, the prevalence of herpes is twice as much in women as compared to men.

The presence of other STDs like HIV infection, chlamydia, gonorrhea, hepatitis B and syphilis all seem to increase the transmission risk of genital herpes.

Consequently, the risk of acquiring genital herpes increases in proportion to the total number of sexual partners. Here are some interesting facts below

  • 1 partner = 2% to 5% infection risk
  • 2 to 4 partners = 7% to 19% infection risk
  • 5 to 9 partners = 10% to 22% infection risk
  • > 10 partners = 19% to 37% infection risk

Does herpes persist for life?

The herpes virus infects the skin and is primarily acquired on contact with an infected partner. To elaborate, active lesions form and then crust over. The virus then travels via the nerve endings and colonize the spinal ganglion cells. Thus, the virus can remain dormant for years in these regions of the body.

On reactivation, the virus travels back to the skin via nerve endings resulting in the production of lesions again. The biggest problem of HSV infections is that patients suffer from

  1. Severe psychological burden about disclosing about the nature of the infection to their sex partners
  2. Also, about the more general dilemma about one’s own conduct as an individual

Some reported complications of herpes include

  1. Disseminated herpes

What are the symptoms of herpes?

Large scale clinical studies have indicated that over 65% of the time, patients are completely unaware of their genital herpes infection. In patients who are symptomatic though, herpes present with lesions that occur on the penis, thigh, buttocks and in areas in and around the private parts. In some individuals, the lesions may occur in the oral cavity.

In some patients, along with the herpetic lesions, mild fever combined with a lymph node enlargement may be seen. HSV 1 lesions are usually milder in nature than HSV 2 lesions. Furthermore, reactivation may not always present with HSV 1 infections, since with HSV 1 recurrence of infections is seen 1 per year on average. However, with HSV 2 the risk of recurrence is much higher and occurs on average 4 to 5 times per year.

Herpes virus shedding can occur in principle throughout the life of the patient. However, the shedding is more seen in the 1st year. Active treatment reduces the shedding of infection.

Nevertheless, complications that have been scientifically reported with herpes include

A. Disseminated herpes

B. Hepatitis

C. Infection of the newborn

D. Meningitis

E. Pneumonitis

F. And lastly, Pelvic inflammatory disease.

The risk of pelvic inflammatory disease is seen in women with past HSV infection. While visiting an infertility specialist, your doctor may order HSV testing in cases a clinical suspicion does arise. Herpes if left untreated during pregnancy is exceedingly dangerous and can lead to miscarriage and sometimes a condition called neonatal herpes.

Herpes Diagnosis

Before proceeding with herpes treatment, establishing a clinical diagnosis is paramount. This is because, HSV 1 and HSV 2 lesions cannot be differentiated visually. Thus testing is a very important guide to management

In the presence of active lesions,  the PCR test is highly recommended for genital herpes testing with sensitivity & specificity of over 95%. However, in the absence of such lesions, in the std clinic, basic serological testing can be done with immunoblot based tests.

These serological tests done with blood have comparable sensitivity and specificity to the western blot method of HSV detection.

Who to test for HSV?

The American Academy of Family Physicians (AAFP) recommends testing for HSV in the following scenarios

  1. In men who have sex with men
  2. In partners of patients who are HSV positive
  3. Moreover, in patients with a clinical diagnosis of herpes but without a laboratory confirmation
  4. Persons infected with HIV
  5. Patients who present to an STD clinic for an evaluation

Counseling patients with HSV infection is tricky, HSV 2 almost always is an anogenital disease. However, HSV 1 is seemingly transmitted in childhood through the oro-labial route. All patients testing positive for HSV 1 should be counseled about the risk of transmitting HSV 1 but also about the risk of being susceptible to get an HSV 2 infection.

Herpes Treatment Strategies Explained

Herpes treatment strategies are primarily aimed at reducing and/or preventing

  1. Firstly virus shedding
  2. Secondly the recurrence of infection
  3. And thirdly, the overall severity of infection

To elaborate further, three antiviral medications are used commonly in herpes treatment. These are Acyclovir, Famciclovir, and Valacyclovir.

The CDC 2015, drug treatment guidelines recommend the following course of medications

A. For patients with suspected primary herpes, a course of Acyclovir 400 mg, three times a day for 10 days OR famciclovir 250 mg three times a day for 10 days

B. For recurrent infection, the dosage is Acyclovir 400 mg three times a day for 5 days OR Famciclovir 1 g twice a day.

An important point to bear in mind is that, although these drugs can reduce viral shedding, they do not completely eliminate the possibility of drug transmission to a non-infected partner.

Furthermore, these drugs do NOT ELIMINATE LATENT INFECTIONS.

However, to conclude, these drugs are quite robust in reducing overall disease severity and should definitely be taken in the event an HSV infection is diagnosed.

That’s about it!

I hope you enjoyed reading this. At our std testing center in Chennai, we specialize in herpes treatment and management. Feel free to get in touch in case of doubts or clarifications

Dr. Shah’s Clinic for Male Infertility & Sexual Health
No 5, Hindi Prachar Saba Rd, Parthasarathi Puram, T. Nagar, Chennai, Tamil Nadu 600017
Ph – 9789843856

References

  1. https://www.aafp.org/afp/2016/0601/p928.html
  2. https://www.cdc.gov/std/herpes/stdfact-herpes.htm

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