Genital herpes

The annoying blisters usually disappear on their own after a while. However, the affected person is still contagious. The symptoms often return after a while. Medication cannot cure genital herpes simplex, it can only reduce the symptoms and prevent those affected from passing on the virus.

Overview: What is genital herpes simplex?

Herpes simplex genitalis is a viral disease. There are two different viruses that cause genital herpes:

• Herpes simplex virus type 1 (HSV-1) is primarily responsible for cold sores, but can also be the cause of genital herpes. They are very common in Europe. Many people are infected with this virus as young children.
• Herpes simplex virus type 2 (HSV-2) causes genital herpes. They are usually transmitted during sexual contact.

There are also other types of herpes virus; herpes zoster, for example, causes shingles.

Infection with herpes simplex often occurs well before the first symptoms appear. Type 2 viruses usually enter the body via the mucous membranes during sexual intercourse. They migrate via the nerve pathways (axons) to the nerve nodes (ganglia) and also infect these. Although the immune system can eliminate many of the viruses, the genetic material (DNA) of the herpes viruses is hidden in the nucleus of the nerve cells. There it can remain undetected for a lifetime and continue to produce new herpes viruses. Once the immune system is weakened, the DNA of the virus reactivates and builds countless new viruses. This causes a secondary infection – often accompanied by the typical blisters on the mucous membrane or skin.

Where can I get infected with genital herpes?

The genital herpes simplex virus can be transmitted in different ways:

• from the mother to the infant at birth
• as a toddler who puts many things in his mouth (especially HSV-1)
• for petting and kissing
• during sexual intercourse in all variations

The virus is transmitted through vaginal and prostate secretions as well as through saliva and semen. The risk of infection is particularly high due to the fluid in the herpes blisters. The viruses are then absorbed via the mucous membranes or tiny injuries to the skin. During oral sex, herpes viruses pass from the lips to the genitals and vice versa. The incubation period of the virus is three to seven days.

Genital herpes: frequency and age

Genital herpes occurs equally in men and women all over the world. In Switzerland, around 70 percent of all adults are infected with the herpes simplex type 1 virus (HSV-1). Herpes simplex type 2 viruses can be detected in one in five cases. Experts estimate that one in 25 Swiss people suffers from the symptoms of genital herpes and three have genital herpes without knowing it. The spread of genital herpes caused by HSV-1 has increased significantly in recent years. Doctors attribute this to changes in sexual practices, among other things. Anyone who has been infected with HSV-1 for a longer period of time will experience less severe or no symptoms on the genitals after infection with HSV-2. But even if the symptoms do not appear, such a person is still contagious. Diseases caused by HSV-2 occur more frequently with increasing age and an increasing number of sexual partners.

Genital herpes: causes and risk factors

The cause of genital herpes is an infection with viruses. The risk of transmission from a man to a woman is around five times higher than vice versa. If you use a condom during sexual intercourse, you can significantly reduce the risk of transmission. However, the viruses may also be passed on despite this protection, as they often spread to the surrounding skin. However, the viruses have often been in the body for a long time before the disease with the conspicuous blisters becomes apparent. A herpes infection can no longer be reversed. The more frequently the sexual partner changes, the higher the risk of infection. Unprotected sexual contact significantly increases the risk compared to the use of condoms.

The following factors can trigger symptoms or reactivation of the virus:

• stress
• Skin irritation/injuries
• Fever
• Sunburn
• Hormone fluctuations (such as in the menstrual cycle)
• Pneumonia
• Tumor diseases
• Irritation of the infected nerve node (e.g. due to inflammation or dental treatment)

Symptoms: Genital herpes manifests itself in painful blisters

There are people who never find out that they have genital herpes simplex. Their symptoms are so weak that they are not aware of them. In many cases, the infection even remains completely asymptomatic. Nevertheless, these people can transmit the virus. Others suffer very severely from the symptoms:

• The skin reddens, burns and itches.
• Blisters form with purulent, encrusted coatings. They are often very painful.
• The inguinal lymph nodes swell.
• You have problems urinating.
• Fever
• Head/muscle/back pain

In most cases, the blisters heal within two to three weeks. However, the disease can break out again at any time later – for example in the event of stress. Such a recurrence usually progresses with milder symptoms.

Clinical picture: Diagnosis by the doctor

Of course, we will first look at the affected area. In the early stages, the typical blisters are sometimes not yet present. The mucous membrane is usually reddened and sensitive. This makes it easy to confuse the viral infection with a fungal infection at the beginning. The situation is clear if there are inflammatory blisters on the genitals. Then we take a swab from the mucous membrane, preferably from a spot with a freshly opened blister. We send this smear to the laboratory. The DNA is used to determine whether an infection with genital herpes simplex is present and which of the two virus forms is responsible.

Genital herpes: prevention, early detection, prognosis

There is currently no vaccination against herpes viruses. You can only prevent it if you exercise caution during sexual contact. Condoms offer some, but not complete, protection against a herpes infection. If you are already infected, you should inform your sexual partners. If you discover blisters on yourself, you should touch them as little as possible and wash your hands thoroughly after touching them. As soon as symptoms occur, you should consult a specialist. The frequency with which the unpleasant symptoms of genital herpes become noticeable again varies greatly from case to case. Some people are never bothered by it again later, others take medication again and again to get the condition under control.

Complications associated with genital herpes

Complications can also occur in individual cases: If the immune system is weakened, genital herpes simplex can spread to the brain and take a life-threatening course. It is relatively common for fungi or bacteria to enter the body via the resulting wound after the blisters have burst, leading to a further infection (superinfection). However, infections of the central nervous system, lungs or liver caused by HSV-2 are very rare. However, HSV sepsis can be life-threatening.

Genital herpes infections are extremely dangerous for newborns. In them, the herpes viruses easily trigger an inflammation of the brain (herpes encephalitis). If a woman suffers from genital herpes, many experts therefore advise a caesarean section. Pregnant women should therefore be sure to inform their doctor about a herpes genitalis infection. Visitors with an HSV infection should also avoid direct contact with newborn babies.

Course and prognosis of genital herpes

After treatment with an antiviral ointment or tablets, the blisters usually heal within two to three weeks. However, the virus itself remains in the body and cannot be eliminated. The disease can therefore break out again at any time, especially at times when the immune system is weakened. In the case of genital herpes simplex, the risk of a relapse is 60 to 70 percent. This means that around two out of three people affected later experience a recurrence of the disease once or several times.

Genital herpes: treatment with ointments and tablets

If you suffer from genital herpes, you should avoid sexual contact until the symptoms have subsided. Your sexual partner should also be tested for the herpes simplex virus if they have symptoms and treated if necessary. Because the risk that he or she has already been infected is high.