Genital herpes

Content

Introduction

Genital herpes is an infection caused by the herpes simplex virus (HSV), of which there are two subtypes: HSV-1 and HSV-2.

HSV-1 generally causes the common herpes of the lips which occurs with blisters that last a few days; HSV-2, on the other hand, causes lesions on the genital mucosa more frequently.

In Italy, genital herpes is one of the most frequent sexually transmitted infections (STIs) in both men and women and is extremely contagious when it is in the so-called phase. active.

Like most herpetic virus infections, when the vesicles disappear (regression of the lesions) the virus remains hidden (latent) in the nervous tissue and, after months or years, it can reactivate due to conditions of stress or weakening of the immune defenses with the reappearance of the lesions (relapse).

Furthermore, it has been shown that the virus can continue to reproduce (replicate) even in the phase in which it does not cause disturbances (asymptomatic phase), albeit imperceptibly.

Since genital herpes can lead, in the most serious cases, to serious consequences for the genital organs and, consequently, jeopardize the possibility of having children, it is important to ascertain (diagnose) and treat injuries in the active phase as soon as possible.

Symptoms

The first infection caused by the herpes virus at the genital level is manifested by single or multiple vesicles at the level of the external genitalia (penis and scrotum in men, vulva and vagina in women) and with underlying inflammation that causes pain or itching and a tendency to create small wounds (ulcerations).

In this phase, the vesicles can disappear and reappear after hours or days and, if left untreated, they can remain for three / four weeks.

When these regress, thanks to the action of the body's defense system (immune system), the virus is not definitively eliminated but is localized within the nerve cells found in the affected areas.
At this stage, said latent, there are no disorders (symptoms) or lesions, but the virus can continue to reproduce (replicate) imperceptibly (read the Hoax).

Its reactivation, usually caused by periods of weakness of the immune system associated with states of psycho-physical stress or serious long-lasting (chronic) illnesses, can cause the vesicles (lesions) to reappear in the site where they first appeared. (primary infection) or in other areas of the external genitalia, in the perianal region and in the surrounding skin.

A therapy started quickly (timely) can limit, in these cases, the extent and duration of the lesions.

Causes

Genital herpes mainly affects adults who have an active sexual life and is mainly transmitted during vaginal, anal and oral intercourse not protected by condoms or dental dam (latex membrane that can be used to protect intercourse or -genital or oral-anal) (read the Bufala).

The probability of contagion is high when the infection is active and the vesicles are present but the virus can be transmitted, albeit with a lower probability, even during the latent phase.

Furthermore, spread can occur by direct contact between genitals or skin or, less commonly, by indirect contact through the hands.

In pregnancy, the virus can be transmitted from mother to child during childbirth and can cause serious complications in the eyes, mucous membranes (oral and nasal) and face, with the risk of compromising the central nervous system and vision.

Diagnosis

The assessment (diagnosis) of genital herpes is usually based on the observation of the characteristic vesicles present on the genital mucosa or on the surrounding skin.

The infection can be confirmed by looking for antibodies to HSV-1 and 2 in the blood. The presence of class M immunoglobulins, the so-called IgM, indicates that it is an "active phase infection contracted for the first time (primary ); that of class G immunoglobulins, called IgG, indicates an "infection already contracted in the past (previous).

It is also possible to search for viral DNA, with PCR method, in the material taken from the lesions through a swab.

Therapy

Genital herpes is able to remain nested in nerve cells for years (latent form) and is therefore extremely difficult to eliminate completely from the body.

During the active phase, the infection can be effectively treated, with the disappearance of disorders (symptoms) and lesions, with specific drugs such as aciclovir, famciclovir, and valaciclovir capable of specifically interfering with reproduction (replication ) of the virus.

Adequate treatment of the primary infection is important to prevent the vesicles from extending, to limit the spread of the virus in the nervous tissue and, above all, to reduce the risk of reappearance of the disorders (relapse) associated with the persistence of the virus in the organism. latent form.

In the case of weakening of the body's defense system (immunodeficiency) due to diseases of viral origin (AIDS) or other causes (severe persistent pathologies), it is essential to treat these conditions.

Prevention

The protection of sexual intercourse with a condom allows effective prevention against genital herpes.

In some cases, however, the lesions may be located in areas (scrotum, perianal skin) that cannot be covered.

It is important to quickly recognize any lesions on the genital organs in order to ascertain their nature, start adequate treatment immediately and avoid spreading the infection to other people.

During pregnancy and before childbirth, control analyzes are prescribed to exclude an "existing infection with HSV-1 and -2, together with the analyzes for toxoplasma, rubella, cytomegalovirus (TORCH).

Living with

If effectively treated, active genital herpes infection tends to resolve itself within a few weeks without causing consequences for the genital organs and reproductive function.

Since the virus generally tends to reactivate in cases of psycho-physical stress and immune weakness, it is important to recognize any relapses as soon as possible to quickly start treatment and avoid unprotected sexual intercourse until the ailments and injuries disappear.

Bibliography

Ministry of Health. Genital herpes

World Health Organization (WHO). Global health sector strategy on Sexually Transmitted Infections 2016–2021 (English)

Salfa MC, Ferri M, Suligoi B et al. Sexually Transmitted Infections: update of the data of the two sentinel surveillance systems active in Italy at 31 December 2014. Newsletter of the Higher Health Institute. 2016; 29

Johnston C, Corey L. Current Concepts for Genital Herpes Simplex Virus Infection: Diagnostics and Pathogenesis of Genital Tract Shedding. Clinical Microbiology Reviews. 2016; 29: 149-61

In-depth link

United Against AIDS (ISS). Genital herpes, sexually transmitted infections

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