Genital herpes is a disease caused by HPV (herpes simplex virus). In 2012, more than 4 billion people under the age of 50 were infected with HPV. In Ukraine, antibodies to HPV-2 were detected in 9.3% of the population. Infections are usually asymptomatic and therefore often go undetected.

Genital herpes – causes, symptoms, treatment

There are two types of herpes virus: HPV-1 and HPV-2. Both infect sensory neurons and can cause lesions at or near the site of entry. HPV-2 is primarily responsible for genital herpes, while HPV-1 contributes to sores on the oral mucosa and skin, but can also cause 30-50% of genital herpes cases. Infection with HPV-2 is more common in women (15.9%) than in men (8.2%). This is probably due to the fact that during sexual intercourse the virus passes more easily from the penis to the vagina than vice versa. Most people may not be aware of the infection and show no symptoms, but the virus can cause life-threatening infections, especially in immunocompromised people.

Genital herpes – how can you get it?

The disease is transmitted by contact of mucous membranes or damaged skin with the genitalia, ulcers or bodily fluids of a person infected with HPV. A person with an active infection with symptoms (ulcers) is most contagious, but transmission also occurs in asymptomatic people. Once the virus penetrates the epithelial cells, it replicates. It then travels to the sensitive nerves and then along the axon to the ganglion innervating the given skin area, where it continues to multiply. Reactivation of the virus is caused by immunodeficiency, severe stress, fever, exposure to UV radiation or tissue damage. 70-90% of people with HPV-2 relapse within a year. 

Genital herpes – symptoms 

Most people who are infected have no symptoms or have mild symptoms that they do not notice. Symptoms appear about 4 days after infection. Symptoms of genital herpes include fluid-filled blisters on or around the genitals, anus or mouth. The blisters burst and leave painful sores that heal in 2-4 weeks. The first episode lasts the longest, is the most contagious and has the most severe symptoms (fever, muscle pain, enlarged lymph nodes). Relapses are shorter and milder.A few days before an impending relapse, the patient may experience numbness, itching or pain in the genital area, thighs or buttocks. Rarely, HPV infection can cause herpetiform meningoencephalitis.  

Genital herpes in pregnancy

Pregnancy promotes reactivation of the virus and can lead to a recurrence of the disease. The course of HPV infection during pregnancy can be more severe and prolonged, and may be accompanied by additional complications. Transmission through the placenta during pregnancy is rare (about 5% of cases), but can cause miscarriage, premature birth, microcephaly, microphthalmia and glaucoma. In 85% of cases the baby becomes infected during labour. The newborn may develop changes in the skin, mucous membranes and eyes, and in the generalised form, liver, respiratory, adrenal and nervous system can be affected. For this reason, pregnant women in the third trimester should not have sexual contact with partners of unknown status or with a diagnosed HPV infection. Already infected pregnant women with active ulcers may be referred for caesarean section. 

Genital herpes – diagnosis

Confirmation of HSV infection is obtained by laboratory tests. Symptoms are non-specific and cannot by themselves confirm the diagnosis. Tests are used:  

direct – consisting of the detection of the virus or its antigens in cell culture, a Zanc test or PCR; usually used in people with visible changes; 

indirect – based on detection of specific IgG antibodies by Western blotting or enzyme immunoassay; this method is most often used in asymptomatic people. 

Genital herpes and HIV

HPV-2 and HIV interact with each other. HPV-2 infection occurs in 60-90% of people infected with HIV, and is one of the most frequent infections in these people. Infection is more severe, with more frequent relapses. Infection with HPV-2 increases the risk of acquiring HIV by up to three times. In addition, people infected with both viruses are more likely to spread HIV to others, due to mucosal inflammation and a greater bacterial biodiversity. 

Genital herpes – treatment

Genital herpes has no treatment. The antiviral medicines used (acyclovir, famcyclovir or valacyclovir) prevent or shorten episodes of symptoms. Taking antivirals daily can also reduce the risk of transmission to your partners. There is also no effective vaccine against HPV. In women in the first and second trimester of pregnancy with symptoms, acyclovir is used for 7-10 days to reduce the risk of transmission through the placenta. 

Genital herpes – prevention

Proper condom use with every sexual intercourse reduces the risk of infection, but does not eliminate it, as the virus can be transmitted through areas not covered by a condom. The most effective method of preventing HPV infection is sexual abstinence or monogamous relations with a partner who has been tested for sex. Daily antiviral medication reduces transmission of HPV-2 in heterosexual couples where one partner has a history of HPV-2 infection.