Individuals who are sexually active are prone to getting genital herpes, a common and contagious sexually transmitted disease (STD). STDs are infections that are transmitted through sexual contact, and they can be caused by bacteria, viruses, or parasites.

What is genital herpes?

Genital herpes is a common sexually transmitted disease caused by the herpes simplex virus (HSV) infection.

Most cases of genital herpes have no symptoms or are unrecognised, even though they may develop painful blisters or ulcers at the site of infection that could range in severity. There are medications available to minimise the severity and frequency of symptoms; however, they cannot cure the disease.

A diagnosis of genital herpes can be emotionally and psychologically stressful. It is essential to discuss with your healthcare professional on how to manage symptoms and prevent virus transmission.

Many people have recurring genital ulcers for several years following infection. Although the infection can remain in the body for years, episodes of symptoms may become less frequent with time. Medication and self-care techniques help control the infection.

What are the causes of genital herpes?

Genital herpes is an infection caused by the herpes simplex virus. There are two types of the virus: the herpes simplex virus type 1 and 2 (HSV-1 and HSV-2). Both types can affect the genitals.

Type 1 can also cause cold sores around the mouth.

Genital herpes is most often caused by HSV-2. It results in painful blisters and ulcers in the genital area. Genital herpes produces painful blisters and ulcers around the genitalia. It can also potentially cause complications if detected for the first time early or very late in pregnancy.

Infection occurs when the herpes virus passes through a break in the skin or penetrates the moist membranes of the penis, vagina, urinary opening, cervix, or anus. Once the skin is invaded, the virus starts infecting the cells.

Sores, blisters, and swelling are caused by the body’s natural defense system as white blood cells react to the infected cells. Although these sores (often called lesions) heal in a few days to a few weeks, some of the virus remains inactive until it is triggered due to an infection, stress, or unknown reasons.

Herpes cannot be contracted through toilet seats, bed linens, or swimming pools. You also cannot contract the disease by touching objects like silverware, soap, or towels.

What are the risk factors of genital herpes?

Oral, vaginal, and anal sex are the most common modes of transmission for the herpes virus.

Oral intercourse with an infected individual who has a cold sore on their lip can also cause transmission of genital herpes, which is often caused by HSV-1. Even when there are no apparent ulcers, transmission from person to person is possible.

Other risk factors include:

  • Sexual intercourse with an infected male compared to an infected female
  • Multiple sexual partners
  • Not using condoms
  • Having a history of sexually transmitted infections
  • Having sex at an early age

What are the symptoms of genital herpes?

Many individuals with genital herpes may not have any signs or symptoms. A minor case of herpes can develop a few lesions that are frequently misdiagnosed as acne or ingrown hairs.

Because genital herpes usually produces no symptoms or relatively minor symptoms, most people with genital herpes are unaware that they have it.

Initial episode

In most cases, the initial herpes outbreak is the most severe, and females tend to experience more severe symptoms than males. Typically, the initial episode happens a few weeks following infection with the virus. In two to three weeks, symptoms often resolve.

Symptoms include:

  • Multiple blisters in the genital area that become painful ulcers
  • Swollen lymph nodes in the groin
  • Joint pain
  • Headache
  • Nausea or vomiting
  • Fever
  • Painful urination

In men, symptoms may appear in the following areas:

  • Penis
  • Scrotum
  • Anus
  • Buttocks
  • Thighs

In women, symptoms may appear in the following areas:

  • Vagina
  • Vulva
  • Buttocks
  • Thighs
  • Anus

Latent stage

During the latent stage, the virus lies dormant at the base of the spine. Symptoms are not present during this stage.

Recurrent episodes

Numerous individuals experience recurring episodes of genital herpes. However, the recurrent episodes are less severe than the initial stage of infection.

Up to 50 percent of individuals with recurrent outbreaks exhibit symptoms prior to the development of ulcers. These are known as prodromal symptoms that include itching, tingling, or discomfort in the buttocks, hips, or legs.

How is genital herpes diagnosed?

Diagnosis is made based on various investigations. Your doctor would first question your general health, symptoms and conduct a thorough physical examination.

It is important to differentiate between genital herpes and other sexually transmitted diseases, especially those that also cause genital ulcers, such as chancroid and syphilis.

Polymerase chain reaction (PCR) test

The PCR test is an exceptionally sensitive test for detecting the herpes virus in cells and secretions from the genital and urinary tracts. This test has more sensitivity compared to the culture test.

Culture test

A culture test can determine the presence of the herpes simplex virus in ulcers and blisters. However, the culture is more likely to detect the virus when ulcers are open and new than ulcers that are healing and older.

Blood test

Blood tests can be done even though a person has no visible ulcers at the time of visit at the clinic but has a history of genital ulcers or may have been infected by HVS previously.

What are the complications of genital herpes?

Complications of genital herpes include:

  • HIV: The likelihood of HIV infection increases by approximately three-fold for those infected with HSV-2.
  • Severe diseases: In immunocompromised individuals, such as those with advanced HIV infection, herpes can cause more severe symptoms and recurrences. Rare complications include meningoencephalitis (brain infection), encephalitis (brain infection) or keratitis (eye infection).
  • Neonatal herpes: Although rare, a newborn can develop neonatal herpes if exposed to HSV during birth. When a mother contracts HSV for the first time in late pregnancy, the risk for newborn herpes is highest. If you have an active infection or prodromal symptoms at the time of delivery, your doctor may recommend a Caesarean delivery as it can reduce contact with the virus.

What are the treatment options for genital herpes?

If you have any of the symptoms of genital herpes mentioned above, speak to your doctor. When genital herpes is left untreated, the chances and severity of recurrence are higher.

Although genital herpes cannot be cured, it can be managed with antiviral medication and self-care measures.

Antiviral medications

Antiviral medications such as acyclovir and famciclovir are used to reduce the severity and duration of symptoms while minimizing the risk of transmitting the virus. The dosage and length of treatment depend on whether it is the initial episode or a recurrence.

Self-care measures

Self-care measures can relieve the pain of a herpes outbreak:

  • Sitting in a few inches of warm water might temporarily relieve ulcer pain. This can be done in your bathtub or a specially designed "sitz bath". Women who have difficulty urinating may find urinating in a sitz bath or at the end of a warm bath helpful.
  • Avoid using bubble baths and soaps. Keep the genital area clean and dry and avoid wearing undergarments or clothes that are constricting or irritating.
  • Additionally, acetaminophen may be used to relieve pain associated with genital ulcers. It is not recommended to use over-the-counter lotions and ointments.

What are the prevention tips for genital herpes?

As all sexually active individuals are at risk of acquiring genital herpes, it is vital to communicate with your sexual partner prior to the first sexual encounter.

Here are some ways genital herpes can be prevented:

  • Use latex condoms during sexual intercourse.
  • Be in a mutually monogamous, long-term relationship with a partner who does not have herpes.
  • Avoid sexual relationships with a partner who has herpes symptoms.
  • Be supportive and discuss treatment plans with your partner. Ensure your partner takes antiviral medications as prescribed by the doctor.

Book an appointment at Pantai Hospitals

Early detection of genital herpes makes treating the condition more effective with appropriate treatment. The caring team of healthcare professionals are available for consultation and to provide the best care.

Get in touch with us to book an appointment with gynaecologists at Pantai Hospitals today if you have any concerns or questions about genital herpes and other sexually transmitted diseases.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

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