When herpes simplex virus infection is not so simple

Sports and other physical activities can trigger groin pains. PHOTO | SALATON NJAU | NMG

What you need to know:

  • Genital herpes is not a sentence to celibacy. Many people with the infection live a full life with no symptoms.
  • The important thing is to avoid sexual contact when one has an active infection and seek treatment. Disclosure to one’s partner is important, as in any other sexually transmitted infection, to facilitate care.

Cedric* woke up in the wee hours of the morning with a weird tingling sensation in his genitals. He was too sleepy to pay much attention but performed his nightly ritual of sleep-walking in the dark to the bathroom, relieving his bladder and finding his way back to bed. It had been a jolly Friday evening with friends, getting back to his bachelor’s pad late and more than a little tipsy.

However, his weekend sleep-in was disrupted by the fire in his nether regions as darkness gave way to dawn and light crept through the cracks in his drawn curtains. The tingling sensation was now feeling like a constant low-grade electric pulsation dancing around his scrotum and penis. He was not at peace.

He drew the curtains to inspect the cause of his distress but all he found was an innocent-looking fine rash on the underside of his penis, extending to the scrotum. The rash did not look capable of causing him such havoc but well, here he was heading to the shower with the hope that the cold water may douse the fire.

By the end of the day, Cedric had given up on home remedies and headed to the hospital. Despite the pain, he did not know how to ask for pain relief while awaiting his turn, so he restlessly passed the hour pacing around and leaning against the wall glaring at everything.

When his turn came, He walked into the consulting room and suddenly he was at a loss of how to explain his symptoms. The doctor asked him about the location of the pain and proceeded to ask him to undress and lie on the couch. She pulled a drape over him and proceeded to get gloved.

The discomfiting questions came fast and steady. In five minutes, he had laid bare his whole sexual history to the doctor under skilled prompting. He was finally at ease when he noted the stoic express on the doctor’s face wasn’t changing. She didn’t even blink when he said he had not used protection in his last encounter despite being with a person he barely knew.

“Looks like you have herpes,” the doctor declared as she tossed her gloves in the bin and proceeded to scribble furiously on the file. She counselled him on the need to screen him for other infections, including HIV, alongside running a few tests to confirm her suspicions. She sent him for a shot to ease his pain and then to the lab.

When Cedric got back to the doctor, he was still in pain but it wasn’t as bad. The doctor gave him the good news; he did not have other infections. He also told him that the remaining tests would take a few days to get the results but meanwhile she would start him on medications to take at home to ease the symptoms.

Herpes simplex virus (HSV) comes in two forms: HSV-1 that commonly causes mouth sores and sometimes genital sores; and HSV-2 that predominantly causes genital sores. By the age of 50, two out of every three people have contracted HSV-1, commonly known as cold sores. This type occurs around the mouth and nose and tends to flare when one has a cold. It is transmitted through close contact hence the need to discourage kissing and sharing cutlery when one has an open sore. It can be transmitted to the genital area through oro-genital sex (oral sex).

HSV-2 is less common, affecting one in 8 people aged 15 to 49 years. This predominantly affects the genital region, hence more likely to be sexually transmitted. However, it may also be transmitted by close contact and by sharing of personal items with someone with active infection.

Burning pain

The genital herpes virus infection usually manifests with burning pain in the affected area, which intensifies as the rash develops anywhere in the genital region, surrounding close areas like the thighs and the anal area. In uncircumcised men, it will also present under the foreskin while in women, it may also affect the cervix.

The rash progresses to break down into shallow and very painful ulcers before they start to dry and heal. Unfortunately, there is no cure for herpes simplex. The antiviral drugs given are to shorten the duration of symptoms and give your own immunity a chance to fight the infection and put it under control. This means the infection lies dormant in your body and from time to time, you may experience relapses.

Complications are rare but can be devastating, especially for special populations. These include newborns, hence the need for aggressive intervention for pregnant women in the third trimester to prevent a flare around delivery. For those who have active disease at delivery, they will require a caesarian section to protect the baby. HSV in newborns can lead to disseminated rash on the skin and mouth, viral pneumonia and viral encephalitis that can be fatal.

Those with immunosuppression also constitute a special category, including those with HIV infection, transplant patients on chronic steroid use and even cancer patients on chemotherapy. They are also at risk of disseminated disease and meningo-encephalitis. They require expensive, long-standing treatment and may even require intensive care.

Genital herpes is not a sentence to celibacy. Many people with the infection live a full life with no symptoms. The important thing is to avoid sexual contact when one has an active infection and seek treatment. Disclosure to one’s partner is important, as in any other sexually transmitted infection, to facilitate care.

Dr Bosire is an obstetrician/gynaecologist

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