Both HSV-1 and HSV-2 cause common infections with variable clinical manifestations in otherwise healthy individuals, whilst these infections tend to be more severe in immunosuppressed children and adults.
Herpes genitalis in males has milder symptoms and occurs less frequently than in females.
Herpes simplex viruses 1 and 2 are also known as Herpesvirus hominis, they belong to the alpha herpesvirus group. HSV possesses an internal core with a linear double-stranded DNA. Its molecular weight is approximately 100×106 units and diameter of about 160 nm.
HSV-1 is transmitted by oral-to-oral contact and exposure to infected saliva, whereas HSV-2 is a sexually transmitted infection.
Despite the common thought that genital herpes is caused by the HSV-2 in some cases it may be caused also by the HSV-1.
Risk factors for herpes genitalis
- Sexually active lifestyle;
- Negroid race;
- Big number of sexual partners;
- Poverty or low income;
The incubation period of primary genital herpes may last from 2 to 14 days.
The first episode of genital herpes manifests with flu-like symptoms such as fever, headache, general malaise, and muscular pain. Pain, itching, dysuria (painful urination), vaginal and urethral discharge, and the painful enlargement of the local lymph nodes are characteristic. These symptoms occur between day 7 and 11 of the illness.
Widely spaced lesions on the genitalia are observed on examination, including vesicles, pustules, painful erythematous ulcers, and crusting. The cluster of vesicles appear on the red surface of the skin on the glans or shaft of the penis.The lesions persist for approximately 21 days. However, in males the lesions heal faster.
Recurrent herpes genitalis usually lasts less than the primary infection with the duration of 7 to 10 days and the rash is not so abundant. In the first year after the primary herpes genitalis from 4 to 5 disease recurrences may develop, although they are milder and relatively shorter. Several hours prior to a recurrence itching, burning, tingling, or tenderness may be observed.
An autonomic dysfunction with urinary retention, erectile dysfunction, constipation and sensory losses may develop due to primary genital herpes. Somwtimes herpes genitalis may affect male fertility.
Read also: Infertility in Men
The diagnosis is made based upon clinical features and laboratory tests such as DNA or PCR tests and virus cultures.
Herpes simplex virus infection requires treatment with acyclovir, valacyclovir or famciclovir administered intravenously or orally. Topical use of these medications is not effective enough.
Reccurent infection does not always require treatment as it turns out to be self-limiting, but therapy may reduce the duration of the disease and symptoms severity.
- a) Primary infection:
- oral acyclovir (200 mg 5 times per day or 400 mg three times a day),
- valacyclovir (1 g twice a day),
- or famciclovir (250 mg twice a day).
The therapy lasts for 7–14 days.
- b) Symptomatic recurrent genital herpes:
- Short-course (1- to 3-day) oral administration of acyclovir (800 mg three times a day for 2 days), valacyclovir (500 mg twice a day for 3 days), or famciclovir (750 or 1000 mg twice a day for 1 day, a 1500-mg single dose) is considered effective.
Knowledge of a partner’s infection, diagnosis and treatment reduces the risk of HSV-2 transmission. Chemoprophylaxis and consistent condom use are known to decrease the transmission rates as well. Male circumcision decreases both HIV-1 and HSV-2 acquisition risk in men.