The infection in the genital area with the herpes simplex virus is one of the most common sexually transmitted diseases. However, more than half of those affected are unaware that they have an infection, thus spreading the virus unnoticed.
Of microbes and humans
"Herpes" is the colloquial abbreviation for an infection with the herpes simplex virus (HSV). Mostly meant are the blisters on the lips and on the face (herpes labialis). These are usually caused by HSV type 1 and are usually the first time in childhood.
That there is also a genital herpes infection is less well known. Responsible for this is usually his brother, the HSV type 2, where in 20-30% of cases, type 1 is the culprit. Both forms have in common that they do not disappear from the body after the initial infection, but settle down in nerve endings at home. As soon as the attention of the body's immune system wears off or turns to other things, the viruses multiply and migrate to their preferred sites on the skin and mucous membranes. Usually this is accompanied by a typical bubble thrust.
How often the viruses make themselves felt year after year varies greatly from person to person. Overall, the incidence and severity of outbreaks decreases with age. However, such reactivation can also be without symptoms. This is particularly treacherous because the viruses still multiply and - unnoticed by the person affected - excreted through the mucous membranes and can be carried on with it.
The second dangerous aspect is that herpes and AIDS viruses mutually reinforce one another, ie mutually increase the risk of becoming infected with the other disease and increasing its severity. Experts worry that this could trigger a vicious cycle leading to an HIV epidemic. Thus, according to the World Health Organization, for example, in eastern and southern Africa, the proportion of HIV infection caused by HSV infection is estimated at 60-80%!
Hard facts and dark numbers
Both types of viruses are very common worldwide. In Germany, just under 90% of the population come into contact with Type 1 during their lifetime; with type 2 it is about 15%. In the US, the share is slightly higher at 22%. Overall, infection rates worldwide seem to be slowly increasing in recent years; However, local studies suggest that the infection in Germany tends to decline.
In pregnant women with genital herpes, there is a risk that they transmit the infection to their child during birth (herpes neonatorum). This occurs in about one in every 7, 500 births. Particularly high (30-50%) is the risk of transmission if the pregnant woman becomes infected in the last third of the pregnancy. Consequences are in the child then in 25-40% life-threatening encephalitis (encephalitis) and septicemia (sepsis), which ends in 80-90% fatal. The delivery in such cases takes place by caesarian section. If the pregnant woman already had a herpes infection in the past, the risk for the newborn is much lower.
It is discussed whether a general screening helps to identify in time possible risk births. At present, this is only useful for patients at high risk for STDs, those infected with HIV and those whose partners are infected with HSV-2.
Symptoms and course
After the initial infection, there is a reddening and swelling of the genitals 2-7 days later - in men, especially the glans, foreskin or penis shaft, in the female labia and vagina - which is often accompanied by distension, itching, burning and pain as well as glassy discharge. If the viruses were transmitted during oral or anal intercourse, the symptoms show up in the appropriate place. A little later, grouped, fluid-filled vesicles develop, which break up 1-2 days later, then dry, crust, and heal without scarring about 2-3 weeks later. During this time there is a risk of infection.
The lymph nodes in the groin can swell and it may - especially in the initial infection - come to general symptoms such as fatigue, headache, muscle pain and fever. In principle, genital herpes infections are much more painful than "normal" cold sores. Complications are the grafting of a bacterial infection on the damaged skin and - especially in patients with immunodeficiency - the spread of infection throughout the body with inflammation of the lungs, liver or brain.
Proof and therapy
Most disease course and symptoms already provide crucial clues. The detection of the viruses is carried out by culturing bubble content on special nutrient media. An additional blood test shows whether the immune system has formed antibodies, ie an infection has taken place. For the treatment virus-inhibiting agents (antivirals, eg acyclovir) are used in the form of tablets or ointments. In severe cases, infusions can also be given.
The medications relieve the symptoms and shorten the healing time; however, the viruses remain in the body. During the symptoms and treatment should be dispensed with sex. The contact of the affected areas should be avoided in order not to transmit the pathogen to other parts of the body.
Current drug trials suggest that a vaccine will be available in the foreseeable future. Currently, two remedies are under review, but with some teething problems: one protects only women, the other stimulates the immune system, but then shows no efficacy in the clinical trial.
In a nutshell
- Genital herpes is common worldwide and is mostly caused by HSV type 2. The virus stays in the body for life.
- Herpes and AIDS viruses mutually reinforce each other.
- Many sufferers know nothing about their infection. Infection occurs through mucosal contact or contact with the vesicle contents.
- Condoms (even during oral sex) protect against infection.
- Therapy with acyclovir only eliminates the symptoms.