What is genital herpes?

Genital herpes is one of the most common sexually transmitted infections. It is caused by herpes simplex virus type 2 (HSV-2) or, more frequently, by herpes simplex virus type 1 (HSV-1). Both pathogens are enveloped DNA viruses sensitive to disinfectants and environmental factors. Due to significant genetic similarity between HSV-1 and HSV-2, there are many biological similarities and antigenic cross-reactions between the viruses.

The primary mode of transmission for both HSV-1 and HSV-2 is direct contact. Primary infection with herpes simplex virus-1 most often occurs in childhood after the disappearance of maternal antibodies during the first year of life. Starting from the age of 40, it is estimated that infection with herpes simplex virus-1 is ≥ 85-90%.

Since HSV-2 is predominantly transmitted sexually, infection rates increase only after reaching sexual maturity. Numerous studies have shown higher HSV-2 infection rates in women than in men. A possible reason for this is that men more frequently have asymptomatic genital HSV-2 infections, leading to higher transmission rates from men to women.

Individuals with clinical signs of genital herpes, as well as those with asymptomatic herpes simplex virus infection, can transmit the virus to their sexual partners.

Due to low environmental stability, the herpes simplex virus can remain infectious on moist surfaces for only a few days. Therefore, with normal hygiene practices (including body hygiene), transmission routes other than sexual intercourse do not play a significant role.

Primary genital infections caused by HSV-1 and HSV-2 are usually asymptomatic.

Classic clinical signs include papular (blister-like) or macular lesions on the skin and mucous membranes, appearing approximately 3-7 days after sexual contact; they progress to vesicles, pustules, and ulcers and can last up to 3 weeks.

Typical symptoms also include pain, especially painful inflammatory swelling of the vulva in women, burning, and tingling.

Relatively common accompanying symptoms are lymphadenopathy (enlargement of regional lymph nodes), fever, cervicitis (in women), and proctitis (in men).

After the primary outbreak, the virus remains lifelong in sensory nerve ganglia; in the case of primary genital infection, the sacral ganglia are mainly involved. From there, the virus can reactivate, causing recurrent infections.

Numerous physiological and environmental factors, such as fever, excessive ultraviolet light, menstruation, severe stress or trauma, and air travel, can trigger genital herpes exacerbations.

Recurrences are almost always initially present with prodromal symptoms, such as neurological symptoms, dysesthesia (various abnormal sensations like pain, itching, tingling), or lumbosacral pain 1-2 days before the appearance of skin and mucous membrane lesions. Frequent recurrences of genital herpes particularly affect young women with high stress levels in family and work environments.

Most individuals with a first episode of genital HSV can be treated with oral antiviral medications.

Intravenous administration is usually reserved for treating complicated infections (e.g., central nervous system involvement and disseminated diseases).

Topical therapy should be applied in the form of creams or ointments containing antiviral components.

The 2021 recommendations from the Centers for Disease Control and Prevention (CDC) suggest any of the following oral treatment options:

• Acyclovir
• Famciclovir
• Valacyclovir

As of today, there is no licensed vaccine against genital herpes, although research has been ongoing for several decades. “Therapeutic” vaccines differ from “prophylactic” ones depending on their mode of action. While therapeutic vaccines aim to prevent recurrent herpes simplex virus infections and asymptomatic viral shedding in individuals with latent HSV infection, prophylactic vaccines are designed to prevent primary infection and subsequent viral latency.

Genital herpes is often underestimated not only by patients but also by healthcare providers due to the variability and diversity of its clinical presentation; however, timely detection and treatment significantly improve quality of life.