He Genital herpes It is one of the most common and chronic sexually transmitted infections. In the United States, it is estimated that one in 6 people between the ages of 14 and 49 suffer from it.
There are herpes viruses type 1 and 2. Previously, it was said that type 1 affected the oral mucosa and type 2 the genital mucosa, but this concept is obsolete since 50% of genital lesions are caused by the type 2.
It is a common sexually transmitted infection through skin-to-skin or mucous membrane contact. Women are at greater risk for herpes lesions, as the virus spreads more easily from men to women than from women to men.
Most people with herpes simplex are asymptomatic, that is, they are unaware that they can transmit the virus even without obvious clinical lesions.
Once the virus penetrates the skin, it migrates through the nerve terminals to remain inactive in the regional nerve ganglia. This first infection (primoinfection) can be symptomatic or asymptomatic. In case of reactivation, the virus will migrate through the same nerve terminal until it reaches the skin and causes lesions. These reactivations are more frequent during the first year after infection, spacing out over time.
What symptoms and injuries do they cause?
If the infection is symptomatic, the lesion is manifested by vesicles that rupture quickly, leaving very painful erosions. There may be edema and inflammation of the area, painful bilateral inguinal nodes, and even fever. Exceptionally, the condition is more severe and can make urination difficult or impossible due to edema (swelling) and pain in the area. The condition is self-limited and lasts between 7-21 days.
They present as small painful vesicles on the skin and/or vulvar mucosa. They may be preceded by burning and discomfort in the area. This period is very important to recognize to quickly begin treatment of recurrences.
How is it diagnosed?
The definitive diagnosis is made through the detection of the virus DNA in the lesions using a PCR test (direct method). The sample must be taken by scraping the lesion with a sterile swab and in specific culture media. A negative result does not rule out infection completely. Culture is an option, although its sensitivity is low for recurrences and declines as the lesion heals.
Treatment
It should be based on advice, instructive about its natural history and its reactivations. In order to reduce the severity and duration of symptoms, antiviral drugs such as acyclovir and valacyclovir are used orally. Local treatment with antiviral creams is not recommended, but local anesthetics such as lidocaine are recommended for pain treatment.
Because transmission occurs through direct skin-to-skin contact, the condom is partially protective. However, its use is recommended to reduce transmission. Whenever there are symptomatic episodes, that is, there are lesions, sexual abstinence is recommended until they disappear.
Gynecologist, head of the Vulvar Pathology sector and head of the Gynecology Service of the Italian Hospital.
Source: Ambito

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