diease

Genital Herpes


OVERVIEW OF Genital Herpes :

HSV is a highly contagious yet curable sexually transmitted disease (STD).Genital herpes is a sexually transmitted disease. This STI causes herpetic sores, which are painful blisters (fluid-filled bumps) that can break open and ooze fluid. There are two types of HSV which include HSV 1 and HSV 2. HSV 1 causes cold sores and HSV 2 causes genital herpes.

HSV-1. This is the type that usually causes cold sores or fever blisters around your mouth. HSV-1 is often spread through skin-to-skin contact, though it can be spread to your genital area during oral sex. Recurrences are much less frequent than they are with HSV-2 infection.

HSV-2. This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious, whether or not you have an open sore.

Herpes zoster- This infection causes shingles or chicken pox

 


CAUSES :

Unsafe sexual practices

Multiple sexual practices

Sharing common needles

Failure to screen blood before blood transfusion

Transfer of the virus from mother to foetus

Also spreads by break in the skin surface.

Anal intercourse


PATHOPHYSIOLOGY :

Herpes is contracted through direct contact with an active lesion or body fluid of an infected person. Herpes transmission occurs between discordant partners; a person with a history of infection (HSV seropositive) can pass the virus to an HSV seronegative person. Herpes simplex virus 2 is typically contracted through direct skin-to-skin contact with an infected individual, but can also be contracted by exposure to infected saliva, semen, vaginal fluid, or the fluid from herpetic blisters. To infect a new individual, HSV travels through tiny breaks in the skin or mucous membranes in the mouth or genital areas. Even microscopic abrasions on mucous membranes are sufficient to allow viral entry.

HSV aymptomatic shedding occurs at some time in most individuals infected with herpes. It can occur more than a week before or after a symptomatic recurrence in 50% of cases. Virus enters into susceptible cells by entry such as nectin-1, HVEM and 3-O sulfated heparan sulfate. Infected people who show no visible symptoms may still shed and transmit viruses through their skin; asymptomatic shedding may represent the most common form of HSV-2 transmission. Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV. Concurrent infection with HIV increases the frequency and duration of asymptomatic shedding. Some individuals may have much lower patterns of shedding, but evidence supporting this is not fully verified; no significant differences are seen in the frequency of asymptomatic shedding when comparing persons with one to 12 annual recurrences to those with no recurrences.

Antibodies that develop following an initial infection with a type of HSV prevents reinfection with the same virus type—a person with a history of orofacial infection caused by HSV-1 cannot contract herpes whitlow or a genital infection caused by HSV-1. In a monogamous couple, a seronegative female runs a greater than 30% per year risk of contracting an HSV infection from a seropositive male partner. If an oral HSV-1 infection is contracted first, seroconversion will have occurred after 6 weeks to provide protective antibodies against a future genital HSV-1 infection. Herpes simplex is a double stranded DNA virus.

 


ROUTES OF TRANSMISSION :

Sexual route

Sometimes by blood products.

Touching or exposure arears of the infected person.

     Sexual  Transmission:

About 80% of infections worldwide are transmitted through sexual transmission. The risk of transmission depends on various factors including - sexual partner's viral load, the type of sexual exposure, coinfection with other conditions like HSV and genital inflammation or damage.

    Vertical transmission:

When the bacteria spreads from mother to child during pregnancy, childbirth or during breast feeding, it is called as vertical transmission. The Risk of transmission can be lowered significantly if infection is treated consistently and bacterial load is maintained below the limit of detection.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Inflammation of the urethra- urethritis

Vaginal discharge

Pain

Small tiny blisters

Scabs – the ulcers which forms and heal by itself leaving a scar like tissue

Bleeding in the sore

Dysuria- A condition caused by the urethral discharge


DIAGNOSTIC :

Viral culture: This test involves taking a tissue sample or scraping of the sores for examination in the laboratory and investigations are made.

Polymerase chain reaction (PCR) test: PCR is used to copy your DNA from a sample of your blood, tissue from a sore or spinal fluid. The DNA can then be tested to establish the presence of HSV and determine which type of HSV you have.

Blood test: This test analyzes a sample of your blood for the presence of HSV antibodies to detect a past herpes infection

Immunofluoroscent test: It detects the antibody to the viral infection.

Swab test: the health care physician takes swab from vaginal site and then laboratory investigations are made.

Lumbar puncture: It is done if anyone is suggesting for spinal cord or brain infections.

 


TREATMENT AND PROGNOSIS :

Medical management:

The antiviral medications provide a better relief to the patients. The medicines used are:

Acyclovir

Valacyclovir

Famcicyclovir

  • Empiric treatment for other viral infection and syphilis is also recommended (as they are more common and coinfections may exist).

Surgical management

  • Incision and drainage of suppurative buboes
  • Needle aspiration can be performed, but patients may need repeat aspirations.
  • Without treatment, fistulous tracts and deep tissue destruction can occur.

 


PROGNOSIS :

Recovery and prognosis of the chancroid purely depends upon the size  and severity of the ulcer sores. Large ulcers from HSV might take 2-3 weeks to heal fully


PREVENTION :

  • Limiting or reducing the number of sexual partners
  • using protection during sexual contact or intercourse at all times
  • regularly checking the genital region for signs of abnormal bumps, sores, or swollen lymph nodes
  • talking with sexual partners about testing for STIs or their STI status before engaging in sexual contact
  • asking sexual partners about any unusual sores or bumps in their genital region
  • talking with a doctor about unexplained groin pain
  • getting regular STI testing
  • avoiding or limiting alcohol use and avoiding recreational drug use as these may impair judgment in making healthy choices
  • screening of the blood and other products before transfusion


Medicines used in the Treatment :

Acyclovir

Valacyclovir

Famcicyclovir