Genital Herpes

Key Points
Lifelong skin condition caused by Herpes simplex virus (HSV)
Spread by skin to skin contact
Only 20% of affected persons develop lesions
Consists of red and painful blisters in the affected area, which burst to form small red sores

Genital herpes is a lifelong skin condition caused by the Herpes simplex virus (HSV). While most cases are caused by HSV-2, it is occasionally due to infection with HSV-1. In both types, two different infections may occur, recurrent and primary. In both cases, cutaneous symptoms usually present on the exterior genitalia, perianal skin, buttocks, or thighs.

Primary infections develop approximately one week after initial exposure, and consist of small painful blisters, which burst easily and form red painful sores. During the course of the primary infection, sores will scab over, scabs will fall off and leave red areas which fade over time. The duration of a primary herpes infection is approximately 4 weeks. Primary infections may have severe cutaneous presentation, along with burning during urination and possible discharge from the vagina or urethra. Primary infection may also be accompanied by fever, head and muscle aches, and fatigue.

Recurrent infections tend to be much milder, lasting 5-10 days and generally occurring in the same areas as the primary infection. Recurrent infections may present as pain or burning in the area up to 24 hours before an outbreak occurs. In persons who do not develop symptoms during a primary infection, it is easy to mistake an initial recurrent infection for a primary one, as the lesions are identical. While the number of recurrent infections is variable, an affected person can generally expect approximately 4 outbreaks per year, with that number decreasing over time. While most recurrences are not triggered by outside stimuli, they may be in some cases. Circumstances which may spark a recurrence include illness, sun exposure, hormonal changes, stress, skin or tissue trauma, surgery, immunosuppression, and friction in the area of primary infection.

Genital herpes is caused by HSV, and can only be spread through skin to skin contact. The condition is at its most contagious when sores are present, though it can transmit to others even when they are not. In cases where a primary infection does not display symptoms, affected persons may not even know they're infected and more easily infect others.

Differential Diagnosis (Other conditions with similar appearance)
Aphthous Ulcers
Cytomegalovirus Infection
Enteroviral Infections
Syphilis
Herpes zoster

Diagnosis
Key Points
Diagnosis initially based on appearance of the affected area
Blood tests, lesion cultures, and skin biopsy can be performed to confirm diagnosis

Initial diagnosis of Genital herpes is based on the appearance of lesions in the affected area. The diagnosis will then be confirmed through blood tests, culture, or biopsy of the lesions themselves.

Treatment
There is no cure for genital herpes
Goal of treatment is to control and prevent outbreaks
*Antiviral medications such as Acyclovir can shorten or prevent outbreaks
OTC Options: Acetaminophen, ibuprofen

There is no cure for Genital herpes. Over time, outbreaks may become fewer and fewer, but infected persons will always be potentially contagious. In the case of primary infections, health care professionals will usually treat the condition with oral antiviral medications. Recurrent outbreaks can be prevented with suppressive doses of antiviral medications. Daily suppressive antiviral treatment has also been shown to reduce the likelihood of transmission.