Herpes simplex genitalis

What is it?

Genital herpes is a sexually transmitted infection caused by a virus; in most cases the herpes simplex type 2 virus (HSV-2). This virus causes an infection of the skin and mucous membranes in and around the genitals.

Infection with genital herpes is only possible through sexual contact between people, one of whom has herpes and the other does not. You cannot get genital herpes if you are just 'around' someone who has herpes. The rash on the skin or mucous membrane of the mouth, penis, vagina or anus has to be touched in order to become infected.

It is possible to transfer the herpes infection via your own fingers to another part of the body such as the eyes. You can also get a herpes infection on one or more fingers in this way. It is therefore recommended that the inflamed area with blisters and ulcers be touched as little as possible and that the hands be washed thoroughly after possible contact.

Genital herpes and pregnancy

If you have had genital herpes, you can become pregnant without any problems. It is very important that you tell the GP or midwife.

Symptoms

Evolving symptoms

Typical skin lesions do not look the same at every stage of the disease: these skin lesions evolve and change in appearance. If you have caught a herpes infection, you can have the first symptoms within about one week. There is often itching and an irritated, burning sensation. Red spots appear on the skin or mucous membranes.

One to one and a half days later, blisters or ulcers become visible on or around the penis, labia, entrance to the vagina or anus. The blisters and wounds are not clearly visible yet. The risk of infection is greatest around the time someone has blisters or sores.

The severity of the symptoms varies from person to person. Initial episodes can be accompanied by pain, fever, swollen glands in the groin and sometimes discharge from the vagina. Women in particular often experience pain when urinating. After anal contact with someone who has herpes, an inflammation of the rectum can occur. This is sometimes accompanied by loss of blood or mucus and pain with bowel movements. The blisters and sores dry after about three weeks and usually heal without scars.

If the immune system is severely weakened, a herpes genital infection can be much more serious and prolonged. This is the case, for example, if you have an HIV infection or if you use medications that suppress the immune system (e.g. cortisone).

Recurring symptoms

When the symptoms of the first infection have disappeared, it seems as if the herpes virus has disappeared from the body. Unfortunately, that is not the case. The virus has withdrawn from the skin in a nerve node. It remains there in a dormant state. However, the virus can multiply again and cause new blisters on the skin or mucous membranes. It is impossible to predict how often there will be a new episode. One person can have an episode almost every month, others seldom or never again. It is different for everyone.

Repeat episodes are generally less serious than the first case. It is unknown why episodes often recur in one person and only occasionally or never again in another. It is well known that a good general health condition is important. Episodes mainly occur in situations where the immune system does not function as well as it should. For example, just before menstruation or during a flu. But stress also increases the risk of an outbreak.

How is the diagnosis determined?

If you suspect that you have genital herpes, it is important to see a doctor as soon as possible. She or he can determine whether you indeed have a herpes infection. Because of the risk of infection, it is important for you and your partner(s) to know whether this is an STI. In addition, if you are examined in good time, the doctor can prescribe a remedy that can shorten the duration of the outbreak and reduce its severity.

Prior to the visit, the doctor will ask a number of questions about physical discomfort and other symptoms, (un)safe sexual contact and possible infection of or by your partner(s).

During the physical examination, the genitals and anal region are examined.

In order to make a diagnosis with certainty, fluid is usually taken from the vesicles or ulcers and sent to the lab for testing.

Sometimes, just to be on the safe side, you will also be tested for other STIs.

Treatment

There is no medical product that completely eliminates the herpes virus from the body. That is why the virus can come on again and again. A good physical and mental condition contributes to reducing the number of episodes. Painkillers are sometimes necessary. The use of creams usually has little effect.

Inhibiting drugs

However, there are resources available that have an effect on the duration of the episodes, such as valaciclovir (Zelitrex), aciclovir (Zovirax) and famciclovir (Famvir). These substances inhibit the multiplication of the virus in the body and thus prevent further spread of the episode. The severity of the symptoms is reduced and the duration of the episode is shortened. However, it is important that you start treatment as soon as possible after the onset of the episode.

Informing your partner(s)

If have a dedicated partner it is certainly advisable to discuss the herpes infection with him or her. It may be that the partner has already been infected in the current or previous sexual relationship without having had any symptoms. If you have more than one partner or change them frequently, informing or warning is not considered strictly necessary. If you know who you may have had the herpes infection from, it is a good idea to inform them. This may help to limit further spread of the virus.

Prevention of infection

• If you or your partner are experiencing a herpes episode (i.e. you have symptoms and discomfort), it is better not to have sexual intercourse. If you still have sexual intercourse, use a (female) condom.

• It is better not to have oral sex if you or your partner have a lip sore on the lip or if there are symptoms of genital herpes on the penis or labia, or around the anus.

• Avoid touching the blisters as much as possible. By touching the genitals of a partner who has a herpes genitalis episode, you can get infected if you then touch your own genitals with your hands.

There is no full protection against infection from genital herpes. Not even if you know that your partner is infected with the virus and you take precautions. For example, you can have a herpes infection without having any symptoms. In that case, you have no blisters or red spots, but you can be contagious for others. You could also transmit the virus unnoticed because the blisters are in places where you cannot (properly) see them, for example on the cervix or in the anus. Because a condom never completely covers the genitals, infection is also possible if the blisters are outside the edge of the condom. By acting carefully and having protected sex, you can greatly reduce the chance of a herpes infection.

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip