The genital herpes is a contagious disease transmitted sexually or indirectly by the fingers having been in contact with another body part infected (sores) caused by the virus Herpes simplex (HSV) type 1 or 2.

It consists of itching, burns, blisters, sores in the genitals.

Treatment consists of antiviral drugs to reduce the infectiousness, reduce pain, duration and frequency of seizures. It is considered a minor infection but prevents intercourse during outbreaks.

For AIDS patients, it is an important co-factor for transmission of human immunodeficiency virus responsible for AIDS.

Epidemiology

Genital infections may be caused by the virus Herpes simplex (VHS) type 1 or 2, but HSV-2 is the most common (about 70% of cases). Recurrent infections with HSV-2 are very frequent (98% of patients).

The patients are mostly asymptomatic.

The incidence in the United States is estimated between 1 and 2 million new cases annually. The prevalence among 30-40 years is nearly 30%.

Genital herpes in France is very popular and well cared for. Many people live with without altering their quality of life.

Herpes can be considered a public health problem but the policy of prevention is lacking and knowledge of GPs weak.

Mechanism of contamination

The infection is spread by:

• contact between infected mucosa and mucosa (intercourse);
• skin contact between infected and healthy skin (a person has herpes on testicle and transmits on the buttocks of the partner);
• contact between skin or mucous secretion and vaginal infection;
• Contact between skin or mucous and saliva infected.
• It appears that there is infection in the skin by fluids (saliva or vaginal secretions), it is necessary that the skin is damaged.

When he enters the genital area, the virus may appear anywhere in the genital area (for example, by contact between the glans / buttock but may appear on the vagina during a flare).

The case of self-inoculation from a site of infection prior oral or labial HSV-1 are rare and occur most often during the primary oral infection (one person has herpes on his mouth for the first time touches the blisters and then touches his sex).

The asymptomatic shedding and transmission (the person who is contagious no sign making him think he has a herpes) virus are especially frequent for HSV-2.

History

The first infection (primary infection) is often silent.

The usual incubation period (interval between infection and onset) of primary symptomatic infection varies between 2 and 21 days.

Recurrent infections are usually found on the territory of dermatomes S2 or S3 (area of skin innervated by the second or third sacral root). Recurrences are frequently atypical for their presentation.

Clinical Indications:

Initial infection

This is the first episode in a patient with signs have never been in contact with the VHS until then. There was a rash vesicular and ulcerative point of virus inoculation or nearby. The infection is localized to the genitalia, the pubic area, the perineum and perianal regions, and the neck of the uterus, the anus or the urethra, depending on the type of contact. A lymph node (large ganglion) in the groin, painful, is common. The rash heals without treatment, usually in ten days2.

Urinary problems, including delays in the initiation of urination or difficulty urinating (dysuria), are common among men and women and may last longer.

From 40-70% of primary infections are accompanied by symptoms (e.g. Fever or muscle pain).

A meningitis is benign observed in 10-30% of cases of primary symptomatic infection. The lumbar puncture in this case brings a sterile liquid.

Infection rather than primary

This is the first episode with clinical signs in patients who have had contact with HSV, whether symptomatic or not. The duration is usually shorter, and it is rare that the symptoms of interest to the whole organism.

One can observe a vesicular rash and ulcerative unilaterally or bilaterally (in women) rather akin to recurrent symptomatic infection.

Recurrent infection

The first eruption never appears immediately after infection. It must first be installed before the virus to produce rashes, which may take several weeks. The latency period can occasionally be several years in some patients.

Recurrent symptomatic infection

• It is due to reactivation of latent virus.
• The symptoms are less severe and of shorter duration than in the case of a primary symptomatic infection.
• The manifestations of infection are generally limited to the external genitalia and are unilateral.

Asymptomatic shedding of HSV

It is observed in people with or without symptomatic episodes. It takes place at several locations in the genitals and is more common in the case of HSV-2.

Contribution of the laboratory

To establish the clinical diagnosis, it should find the following: typical or atypical lesions and a culture or other results of specific diagnostic tests.

Culture, after sampling at the level of the lesion, remains the preferred method because of its specificity, its sensitivity and its ability to type strain of the virus. The typing of the strain is desirable in most cases to better predict recurrence and to provide relevant information on the susceptibility of the partner. The polymerase chain reaction (PCR) also helps to establish the diagnosis.

The other laboratory

Serology

It involves the detection of antibodies directed against HSV in the patient’s blood. The detection of these signs prior contact with the virus but in a delayed way. Serology has a limited clinical application. They can be used to determine whether pregnant women who have no history of symptomatic herpes are at risk. It can not determine if it is naturally a primary infection or recurrence but may define the type of virus (I or HSV 2).

Treatment

The treatments are of two types: oral (preventive treatment) or local (ointment to apply, cure for herpes outbreaks). Must be treated systematically and as soon as possible, that is to say from the onset of signs of an outbreak (itching, irritation or discomfort), which would help reduce seizure frequency and related pain.

The use of condoms does not protect completely the risk of transmission of the disease, the latter being reduced by only about 30%3.

In all cases, analgesics may be useful and hygienic care is needed to prevent a bacterial infection superimposed.

Initial infection

The anti-viral treatment is useful for alleviating the symptoms, complications, and excretion of the virus, but it is only effective if administered early in the symptomatic episode. It does not prevent recurrences, unless they are given a longer time2.

Acyclovir 400 mg three times daily for 5 to 7 days

Famciclovir 250 mg 3 times daily for 5 to 7 days

Valaciclovir 500-1 000 mg 2 times a day for 5 to 7 days

Recurrent

Famciclovir 125 mg orally 2 times daily for 5 days

Valaciclovir 500 mg orally 2 times daily for 5 days

Acyclovir 400 mg orally three times daily for 5 days

Other treatments

Many non-drug treatments have been proposed, herbal, dietary supplements or so-called essential oils. None showed any scientifically effective.

Being a sexually transmitted infection, safe sex or abstinence (if lesions are not covered by the condom) is formally discouraged during the eruptive phase.

In a sero-discordant couples (one infected and one healthy) should use a condom for all reports, since it is impossible to predict when the infected person is contagious (it is estimated that at least 5-10% of days of the year the number of days a person without contaminating positive symptoms). This does not preclude contamination by other routes (skin-skin)

For a couple with HIV-discordant unprotected, an estimated 10% chance of infecting a partner each year.

It is not, to date, immunization available.