Blisters Down There? Could Be Herpes – Here’s What to Do

1. Etiology

• Pathogen: Herpes simplex virus type 2 (HSV-2), less commonly HSV-1.
• Features:
  • Lifelong latency in nerve ganglia.
  • Reactivates during immunosuppression (stress, illness).

2. Transmission

• Sexual (vaginal, anal, oral contact).
• Household (rare, via towels during active outbreaks).
• Vertical (mother to child during delivery).

3. Symptoms

Primary infection:

• Fever, headache, myalgia.
• Genital itching/burning.
• Fluid-filled blisters → ulcers → crusts (heals in 2–4 weeks).
• Swollen inguinal lymph nodes.

Recurrences (milder):

• Localized rash without systemic symptoms.
• Prodrome (tingling 24–48 hours before rash).

4. Diagnosis

1. PCR (vesicle swab) — gold standard.
2. ELISA (IgM/IgG antibodies).
3. Viral culture (rarely used).

Note:

• Cross-reactivity with HSV-1 possible.
• Test both partners!

5. Prevention

• Condoms (50% risk reduction).
• Suppressive therapy (acyclovir for infected partners).
• Avoid sex during outbreaks.
• Antiseptics (e.g., chlorhexidine) post-exposure.

6. Treatment

Acute phase:

• Acyclovir 200 mg 5x/day (5–10 days).
• Valacyclovir 500 mg 2x/day (5 days).

Suppressive therapy:

• Valacyclovir 500 mg 1x/day (6–12 months).

Topical:

• Acyclovir cream (speeds healing).
• Antiseptics to prevent secondary infection.

7. How to Recognize?

Red flags:

• Clustered blisters on genitals.
• Painful urination (with urethritis).
• Recurrent “sores” in the genital area.

8. Post-Exposure First Aid

1. Within 2 hours:
   • Apply antiseptic to genitals.
   • Shower with soap.
2. After 5–7 days:
   • Get PCR test (if symptoms appear).
3. Emergency prophylaxis:
   • Valacyclovir 500 mg 2x/day (2 days) — doctor’s prescription.

9. How to Identify Genital Herpes in Others?

Clues:

• Frequent “cuts” in the genital area.
• Complaints of prodromal tingling.
• Unexplained avoidance of sex.

But:

• 80% of carriers are asymptomatic!
• No diagnosis without lab tests.