Genital herpes Causes, Symptoms and Treatment

The herpes genital is a sexually transmitted infection  (STI), characterized by the appearance of small painful blisters on the genitals. These vesicles are transparent and filled with liquid (see diagram).

The symptoms are manifested by outbreaks . The vesicles are visible for 5 to 10 days, then disappear often for several months before reappearing.

Genital herpes is a chronic infection  : it is impossible to get rid of the virus. On the other hand, treatments manage to relieve the symptoms and reduce the frequency of relapses.

Note . Genital herpes is a particular category of herpes . It is caused by a virus of the herpes simplex virus (HSV). Herpes simplex viruses are a large family of viruses that can cause infections in various parts of the body: genitals (genital herpes), in the mouth or on the lips (cold sores or cold sores), on the skin (chickenpox), in the nerves (shingles), in the eyes (ocular herpes), etc. Most commonly, herpes simplex virus type 2 (HSV-2) is responsible for genital herpes, while cold sores are more commonly caused by HSV- 1 (HSV-1).

Who is affected?

The majority of infections occur in adulthood , around age 20 to age 40. In Canada, about 1 in 5 people have genital herpes. In Europe, genital herpes is much less common. On the other hand, it is very common in Africa, where 30% to 40% of people are infected and up to 90% in some populations.

Transmission mode

Genital herpes has peculiarities that cause an unpredictable transmission. We think that :

  • 20% of infected people have no symptoms and are unaware that they carry the virus and are therefore contagious in an unpredictable way ;
  • 60% of infected people have symptoms, but do not know they have genital herpes. Either their symptoms are minor, or they are confused with those of another problem (for example, for the woman, vaginitis or irritation);
  • Only 20% of infected people have symptoms and know they have genital herpes.

It is therefore essential to consult a doctor as soon as possible if you think you have genital herpes, even if the symptoms are minor: see the Symptoms section below.

  • In most cases , genital herpes is transmitted during sexual intercourse vaginal or anal unprotectedwith a person infected with the herpes virus. The latter enters the body by microscopic lesions present on the skin or mucous membranes;
  • The highest risk of transmission is at the onset of a herpes outbreak, when the vesicles are present because the fluid they contain contains viruses. The lesions remain contagious until they have completely dried out. The virus can spread easily at the time of intercourse, even if there is no penetration ;
  • However, in the majority of cases, the genital herpes virus is transmitted when the infected person has no apparent symptoms . Silent reactivation can occur anywhere between the waist and upper thighs, so it does not affect only the genitals. It is the main cause of new infections ;
  • Sexual intercourse between mouth and sex can cause transmission of the cold sore virus to the genitals. The opposite is also possible, but less frequent;
  • Genital herpes is not contracted by indirect contagion, coming into contact with objects used by an infected person (such as a toilet seat and bath towels) because the virus dies quickly once outside the body. You can not catch this virus by contact with the water of the bath and the pool. However, it is recommended that you do not share your razor with an infected person.

Notes for couples

  • A thrust of genital herpes in one of the members of a stable couple does not necessarily mean that there was unfaithfulness. The infection may have occurred before the couple is formed: it can happen that the virus “sleeps” for several years before reactivating ;
  • The transmission of the disease from an infected partner to an uninfected partner depends on the virulence of the herpes crisis, as well as the receptivity of the uninfected partner.

Note. An infected person can see the virus spread from one part of their body to another. For example, the virus can be transmitted by the fingers from the genitals to the mouth or eyes. This is very rare but ocular herpes can cause loss of sight.

Stages of the disease

The first push. Symptoms appear 2 to 6 days after contagion. Generally, the first push causes more intense symptoms than the following. In addition to vesicles, there may be fever , headaches and fatigue. Herpetic lesions may last longer, up to 3 weeks. In more than 20% of cases, the first push is asymptomatic and therefore goes unnoticed.

The period of dormancy. Once the symptoms disappear, the virus rises along the nerves at the base of the spine. It then lodges in a ganglion, where it remains inactive until it is reactivated, for example at the time of a weakening of the immune system.

Recurrences with symptoms. The majority of those infected have at least one recurrence in the first year after the first outbreak. According to some sources, the lesions recur on average 4 or 5 times during this first year. Subsequently, the frequency of recurrences varies greatly: some individuals will only have 2 seizures in their lifetime, while others will have more than one per year. However, as the years pass, recurrences are less frequent and their severity decreases.

The silent reactivations. In this case, the virus is reactivated but it does not cause visible symptoms, while being very contagious . Silent reactivations are more common in women with genital HSV-2 infection than those with HSV-1 (55% versus 29%). There could be a similar difference in men.

Consequences and possible complications

In healthy people, genital herpes usually does not have serious physical consequences. However, when the immune system is weakened (by another disease, for example), the symptoms may be more severe and last longer.

Even though physical injuries are not dangerous, the psychological stress caused by genital herpes can be difficult to live with. Affected individuals may be embarrassed to talk about their illness and be afraid to share it with their partner. This infection has profound consequences on the intimate and sexual life, which can lead to depression.

In rare cases, the virus can cause meningitis or encephalitis (inflammation of the brain). The infection of the eye (ocular herpes) can cause corneal damage and even blindness.

Note. People infected with the herpes simplex virus are at increased risk of contracting the human immunodeficiency virus (HIV) if they are exposed to it during sexual intercourse.

Symptoms of genital herpes

The first outbreak of herpes is sometimes preceded or accompanied by headaches, fever, fatigue, muscle aches, loss of appetite and swollen ganglia in the groin.

recurrence of genital herpes lasts an average of 5 to 10 days and can sometimes last up to 2 or 3 weeks. Here are the main symptoms:

  • Warning signs , such as sensitivity, tingling, or itching in the genital area, may indicate the onset of a seizure. Fever and headaches can also occur. All of these symptoms are called “prodrome”. In general, this is manifested 1 or 2 days before the appearance of the vesicles;
  • Small transparent vesicles most often grouped together, forming a “bouquet” then appear in the genital area . When they break, they form small, raw ulcers, then crusts. These lesions take a few days to heal and leave no scars;
  • In women , vesicles can form at the entrance of the vagina, on the vulva, on the buttocks, on the anus and on the cervix.
    In man , they can appear on the penis, the scrotum, the buttocks, the anus and the thighs, and in the urethra;
  • The urination can be painful when urine comes into contact with the sores.

People at risk for Genital herpes

  • People with a deficiency of the immune system caused by the human immunodeficiency virus (HIV), by a serious illness, by an organ transplant, etc;
  • The women. Men are more likely to transmit genital herpes to a woman than vice versa;
  • Homosexual men.

Risk factors

By transmission:

  • Unprotected sex;
  • A lot of sexual partners in a lifetime.
    Precision . Having a large number of uninfected sexual partners does not increase the risk of contagion. However, the higher the number of partners, the more likely one is to be infected (often the person does not know it or has no symptoms);
  • A recently infected partner. Silent reactivation occurs more frequently when the first push is recent.

Factors triggering recurrences:

  • Anxiety, stress;
  • Fever ;
  • The period ;
  • Irritation or vigorous friction of the skin or mucous membranes;
  • Another disease
  • A sunburn ;
  • Surgery;
  • Some drugs that suppress or reduce immune responses (especially chemotherapy and cortisone).

Transmission of the virus from mother to child

If the virus is active at the time of delivery, it can be transmitted to the baby.

What are the risks?

The risk of a mother transmitting genital herpes to her baby is very low if she has been infected  before pregnancy . Indeed, his antibodies are transmitted to his fetus, which protects him at the time of delivery.

On the other hand, the risk of transmission is  high  if the mother has contracted genital herpes during pregnancy, especially during the  last month . On the one hand, she does not have time to transmit protective antibodies to her baby; on the other hand, the risk of the virus being active at the time of delivery is high.


Preventative measures

Infection of a newborn with the herpes virus  can have serious consequences because the baby does not yet have a highly developed immune system: he may suffer from brain damage or blindness; he can even die. Therefore, if a pregnant woman has a first genital herpes infection near the end of her pregnancy or if she has a recurrence at the time of delivery, a caesarean section is strongly recommended.

It is  important  that pregnant women who have been infected before their pregnancy  notify their doctor . This may, for example, prescribe an antiviral drug towards the end of pregnancy to reduce the risk of recurrence at the time of delivery.

If the partner of an uninfected pregnant woman carries the virus, it is very important that the couple apply the basic measures to prevent the transmission of HSV to the letter (see below).


Prevention of genital herpes

Why prevent?
  • Once one has been infected with the genital herpes virus, one carries it for the rest of one’s life and one is exposed to multiple recurrences;
  • By taking care not to contract genital herpes, one protects oneself from the consequences of the infection and one also protects one’s sexual partners.
Basic measures to prevent transmission of genital herpes
  • Do not have genital, anal or oral sex with someone who has lesions until they are completely healed;
  • Always use a condom if either partner has the genital herpes virus. Indeed, a carrier is still likely to transmit the virus, even if it is asymptomatic (that is to say, it has no symptoms);
  • The condom does not completely protect against the transmission of the virus because it does not always cover the infected areas. To ensure better protection, a female condom can be used to cover the vulva;
  • The dental dam can be used as protection during oral sex activities.
Basic measures to prevent recurrence in an infected person
  • Avoid triggering factors. Careful observation of what happens before a flare can help determine the circumstances that contribute to recurrence (stress, medication, etc.). These triggering factors can then be avoided or reduced as much as possible. See the Risk Factors section.
  • Strengthen your immune system. The control of recurrence of infection with the herpes virus is largely based on vigorous immunity. Healthy eating (see Nutrition), adequate sleep, and physical activity are some of the factors that contribute to good immunity.
Can we detect genital herpes?
In clinics, genital herpes is not tested, as is the case for other sexually transmitted infections(STIs) such as syphilis, viral hepatitis and HIV.

In some cases, however, a doctor may prescribe a blood test . This test detects the presence of antibodies against the herpes virus in the blood (HSV type 1 or 2, or both at the same time). If the result is negative, it makes it possible to establish with a good certainty that a person is not infected . However, if the result is positive, the doctor can not say for sure that the person is really affected because this test often generates false positive results. In case of a positive result, the doctor may also rely on the patient’s symptoms, but if he does not have one or never has, the uncertainty increases.

The test can be helpful in diagnosing herpes, for people who have had recurrent genital lesions (if they are not apparent at the time of the doctor’s visit). Exceptionally, it can be used in other cases.

If you wish, discuss with your doctor the suitability of this test. Note that it is normally necessary to wait 12 weeks after the onset of symptoms before taking the blood test.

Medical treatments for genital herpes

When you consult a doctor as soon as the vesicles appear (within 48 hours), there are two advantages:

  • The diagnosis is easier because the doctor can take a sample of fluid present in the vesicles;
  • A treatment applied from the first symptoms reduces the duration of the crisis.

Spot treatment

When  herpes attacks  are  infrequent , they are treated as they occur. The doctor prescribes oral anti-viral medications: aciclovir (Zovirax), famciclovir in Canada (Famvir), valaciclovir (Valtrex in Canada, Zelitrex in France). They reduce the intensity of the symptoms and accelerate the healing of the lesions.

The earlier you take antivirals (as early as the warning signs of a seizure), the more effective they are. It is therefore important to have some in advance at home.

Suppressive treatment

In case of frequent seizures , the doctor prescribes the same drugs as the one-time treatment but at a different dosage and for a prolonged period (1 year and more).

Taking long-term antiviral drugs has two advantages: it reduces the number of seizures and can even stop them; it also reduces the risk of transmission of genital herpes. The risk of recurrence could thus decrease from 85% to 90%.

Caution. Anti- viral, cortisone or antibiotic creams should not be used over-the-counter . These products (especially those based on antivirals) are only used in cases of cold sores. In addition, creams containing cortisone may slow healing. The application of rubbing alcohol is absolutely useless and only creates a burning sensation, no more.

What to do when a thrust occurs

  • Avoid having genital or oral sex during the crisis. Wait until the symptoms have disappeared and all the lesions have completely healed;
  • Make an appointment with your doctor, if you do not have at home, reserve of antiviral drugs prescribed;
  • Avoid touching the lesions so that the virus does not spread elsewhere on the body. If touched, wash hands each time;
  • Keep lesions clean and dry.

Measures against pain

  • Put Epsom salt in the bathwater: this can help cleanse and sanitize the lesions. Epsom salt is sold in pharmacies;
  • Apply an ice pack to the lesions;
  • Give preference to loose clothing made of natural fibers (avoid nylon);
  • Avoid touching or scratching lesions;
  • If necessary, take a painkiller such as paracetamol (Doliprane, Efferalgan …);
  • If you experience pain during urination, pour lukewarm water over the painful area when urinating, or urinate in the shower just before leaving.

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