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Herpes genitalia: A never ending viral infection

Herpes genitalia: A never ending viral infection
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Herpes genitalia is a very commonly complaint problem at my Urologic office. Since the painful genital ulcer is the classical symptom for this condition, it is not hard for urologist to make a diagnostic in this condition, so in this topic we will match up with frequently ask questions from the patients for example, where it from? Why it happens to me? Is it curable or not? How to prevent the recurrences?

Skin HSV
Example of Herpes infection at buttock Ref: Campbell Walsh Wein Urology standard textbook.

Herpes genitalia were caused by a Herpes simplex virus (HSV) which is consisted of 2 strains.

  1. HSV-1 strain – Commonly live at perioral area so mainly playing role on the oral ulcer but sometimes also causes Herpes genitalia.
  2. HSV-2 strain – Commonly live at genital area so majoring causes the Herpes genitalia, that is our topic today.
HSV 1
Oral ulcer also caused from Herpes simplex virus.

The primary route of transmission wills directly contacting to secretions in seropositive patients (visible lesions). Once the initial exposing is occurred, painfully genital ulcer or vesicular clusters will be expressed at the contacted region. Typically, 14 days after that, the symptom is subsided, and the virus will hide in our nervous system and become hibernate stating. The only thing capable keeping them inactive is the patient’s immunity.

STD
Directly contact with HSV patient’s secretion is the main transmission route.

Once the patients in low immune state for example.

  • Any kind of medical illness.
  • Too much working which lead to lack of enough sleeping.
  • Mentally stress.
Stress
Too much of work which leads to less sleep resulting in low immune state.

Then HSV become reactivate which made it travel back to the genital skin and express the symptom again. This vicious cycle will repeatedly happen again and again for life.

The way to make diagnosis of Herpes genitalia can be varied regarding to the situations.

  1. If the symptom is obvious or had well-recognized history of Herpes genitalia before, the diagnosis can be done by clinical-only diagnostic.
  2. Tzank smear – we use specimen from direct swab at the vesicular lesions.
  3. HSV PCR test – we use intravenous blood sampling in case direct swab is not possible.
Tzank
Tzank smear which does by sampling the lesion for microscopic studying can give us a valuable information.
Blood sampling
Blood sampling for PCR study is definite investigation in Herpes simplex infection.

The treatment of Herpes genitalia is anti-viral agents which will be benefit in term of both reduce the duration of the symptoms and the transmission period. There was a paper disclosed that the Herpes genitalia will be resolved by itself in 19 days without any intervention. Here are the approval of antiherpesviral agents.

  • Acyclovir – Standard formula with low side effects.
  • Valacyclovir – Better intestinal absorption.
  • Panciclovir – Topical therapy for HSV labial.
  • Ganciclovir – Additional effect against another virus, Cytomegalovirus (CMV)
Penile HSV
Example of Herpes simplex infection at penile skin Ref: Campbell Walsh Wein Urology standard textbook.

Unfortunately, there is no approval for HSV vaccination nowadays, and one more thing, HSV genitalia was also associated with the other kind of STDs, so better to checkup all STDs if possible. There is no other advice to give you more than you “just keep yourself healthier” then you will free from Herpes genitalia. Take care and see you in next article!

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