Genital Herpes Simplex

Overview – Genital Herpes Simplex

Genital herpes simplex is a common and lifelong sexually transmitted infection (STI), primarily caused by herpes simplex virus type 2 (HSV-2), though herpes simplex virus type 1 (HSV-1) can also be responsible. It presents with painful, vesicular genital lesions and recurs due to the virus’s latent residence in neuronal tissue. Clinicians must be able to recognise its features, provide symptomatic and suppressive therapy, and counsel patients on transmission and recurrence risks.

Definition

Genital herpes simplex is a viral STI caused by HSV-2 or HSV-1, leading to episodic outbreaks of painful genital ulcers due to reactivation of latent virus in sensory neurons.

Aetiology

  • HSV-2: Primary cause of genital herpes (approx. 12.5% population prevalence)
  • HSV-1: Classically causes oral herpes but increasingly implicated in genital infections (approx. 70% prevalence overall)
  • Transmission occurs via direct contact with mucosal surfaces or broken skin

Pathogenesis

  • Virus enters via mucocutaneous contact
  • Phase 1: Infects epithelial cells → moves to sensory neurons
  • Latency: Lives dormant in dorsal root ganglia
  • Reactivation: Stimuli (stress, illness, etc.) trigger virus to travel down axons to skin → recurrent lesions

Morphology

  • Papular and vesicular lesions on external genitalia
  • Vesicles may rupture → painful ulceration

Differential Diagnosis

Consider other causes of genital ulcers:

Clinical Features

  • More common in women (2F:1M)
  • Incubation: <3 weeks
  • Prodrome: Paraesthesia, itching, redness
  • Lesion stage: Clusters of painful vesicles → ulceration
  • Course: Symptoms resolve within 2 weeks (if untreated)
  • Recurrence:
    • Shorter, milder
    • 1–2 day prodrome (e.g. tingling)
    • HSV-2: ~5 recurrences/year
    • HSV-1: ~1 recurrence/year
    • May include cervicitis or proctitis

Red Flag: Any red-edged, scabbed, multiple painful genital ulcers = consider herpes!

GENITAL HERPES SIMPLEX
Creative Commons: https://en.wikipedia.org/wiki/File:SOA-Herpes-genitalis-female.jpg

Investigations

  • Clinical diagnosis is usually sufficient
  • Swab of vesicle: HSV PCR (type 1 or 2)
  • Tzanck smear: Shows multinucleated giant cells (not specific)
  • Serology: Limited diagnostic value due to high background prevalence

Management

Note: No cure – aim is symptom relief and reducing transmission

Antiviral Therapy

  • Valaciclovir, famciclovir, or aciclovir
  • Nucleoside analogues
  • Regimen: e.g. BD for 10 days (acute); longer for suppressive
  • Suppressive therapy reduces transmission by ~50%

Symptomatic Relief

  • Lignocaine gel for pain
  • Adequate analgesia as needed

Counselling and Education

  • Abstain from sex during active lesions or prodrome
  • But: asymptomatic viral shedding still occurs
  • Discuss recurrence expectations
  • Emphasise condom use and partner testing

Complications

  • Recurrent outbreaks
  • Psychological distress
  • Neonatal herpes (if transmitted during childbirth)
  • Proctitis/cervicitis in some cases

Summary – Genital Herpes Simplex

Genital herpes simplex is a lifelong STI caused by HSV-1 or HSV-2, characterised by recurrent painful genital lesions. Diagnosis is usually clinical, supported by PCR testing. Management is centred on antivirals, symptom control, and patient education. For a broader context, see our Reproductive Health Overview page.

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