Genital herpes – infection, symptoms and other causes

Genital herpes is a very common infection which is caused by HSV – herpes simplex virus [1]. This causes painful blisters on your genitals and surrounding areas. Genital herpes can be passed to others when they have intimate sexual contact and it is often referred as STI (sexual transmitted infection). Herpes simplex virus can affect any mucous membranes (moist lining) such as those that are found in the mouth (known as cold sores). Genital herpes is a chronic condition (a long – term condition). This virus remains in our bodies and it can become active again. The average rate of recurrence of this virus is 4 – 5 times in the first two years after being infected [2]. But over time, this virus tends to become active less frequently and each outbreak becomes less severe.

Symptoms of genital herpes

Most people who suffer from the herpes simplex virus are not experiencing any symptoms of genital herpes when they are first infected. This is a reason why many people do not know that they are infected. If someone experiences symptoms when they are first infected, then they usually appear 4 – 7 days after they have been exposed to this virus. The symptoms of this infection are more common when they are first time in the body compared to cases when it is recurrent.

1. Primary infection: The symptoms of the genital herpes when it is the first time are:

• A general feeling of being unwell, with aches, pains and flu – like symptoms
• Pain when you pass urine
• Vaginal discharge in women
• Blisters and ulcers on the cervix (lower part of the womb) in women
• You can have small blisters that burst to leave red, open sores around your genitals, rectum (back passage), thighs and buttocks

The symptoms of the primary infection may last up to twenty days. The sores will eventually scab and they heal without scarring.

2. Recurrent infections: The initial symptoms of this infection can clear up, but this virus remains dormant (this means it is inactive) in a nearby nerve. This virus can be reactivated from time to time and it can travel back down the nerve to your skin and it is causing recurrent outbreaks. Here are the symptoms of the recurrent outbreak:

• Blisters and ulcers on the cervix (lower part of the womb) in women
• Painful red blisters that soon burst to leave sores around your genitals, rectum (back passage), thighs and buttocks
• You can feel a burning, itching or tingling sensation around your genitals and sometimes down your leg, before blisters appear

Recurrent outbreaks are usually shorter and they are less severe. This is because our bodies have produced protective antibodies (those are proteins which fight infection) in reaction to the previous infection. Our bodies now are recognizing this virus and they mount a response that is able to fight herpes simplex virus more effectively. Over time, we should find any recurrent genital herpes infections become less severe and less frequent.

Causes of genital herpes: This infection is caused by the herpes simplex virus. It is known that this virus is highly contagious and it spreads from one person to another through skin – to – skin contact such as during oral, anal or vaginal sex [3]. There are two types of the herpes simplex virus:

1. HSV – 1 (type 1)
2. HSV – 2 (type 2)

Genital herpes can be caused by both type 1 and type 2 herpes simplex virus. Whenever this virus is present on the surface of your skin it can be passed to your partner. This virus is passing easily through the moist skin which lines your genitals, mouth and anus (the opening where solid waste leaves the body). [4]

Genital herpes

Recurrence triggers: It is not understood why this virus is reactivated, but there are some triggers which can be responsible for the symptoms of genital herpes recurring. Friction in the genital area during sexual intercourse can cause a recurrence. When you use lubricant, then this can help. You can find lubricants in pharmacies and they do not need a prescription. Other possible triggers are:

• Surgery on your genital area [5]
• Exposure to ultraviolet light, for example, using sun beds [6]
• Drinking excess amount of alcohol [7]
• Stress [8]
• Being unwell
• Having a weakened immune system (the body’s natural defense system), for example as a result of having chemotherapy (treatment for cancer) is also a cause of genital herpes. [9]

References:

[1] Koelle DM, Corey L. Recent progress in herpes simplex virus immunobiology and vaccine research. Clinical Microbiology Reviews. 2003;16(1):96–113.

[2] Phipps W, Saracino M, Magaret A, et al. Persistent genital herpes simplex virus-2 shedding years following the first clinical episode. Journal of Infectious Diseases. 2011;203(2):180–7.

[3] World Health Organization. Herpes simplex virus. 2020. Retrieved from www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

[4] FPA. Genital herpes. Retrieved from www.fpa.org.uk/sites/default/files/genital-herpes-information-and-advice.pdf

[5] Arinze F, Shaver A, Raffanti S. Surgical excision for recurrent herpes simplex virus 2 (HSV‑2) anogenital infection in a patient with human immunodeficiency virus (HIV). Infection. 2017;45(5):705–7.

[6] Ludema C, Cole SR, Poole C, et al. Association between unprotected ultraviolet radiation exposure and recurrence of ocular herpes simplex virus. American Journal of Epidemiology. 2014;179(2):208-15.

[7] Tassiopoulos KK, Seage G, Sam N, et al. Predictors of herpes simplex virus type 2 prevalence and incidence among bar and hotel workers in Moshi, Tanzania. The Journal of Infectious Diseases. 2007;195(4):493-501.

[8] Cohen F, Kemeny ME, Kearney KA, et al. Persistent stress as a predictor of genital herpes recurrence. Archives of Internal Medicine 1999;159(20):2430-6.

[9] Shin H, Iwasaki A. Generating protective immunity against genital herpes. Trends in Immunology. 2013;34(10):10.1016/j.it.2013.08.001.