Genital herpes is a sexually transmitted infection. It is caused by the herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) (Parra-Sánchez, 2019). These viruses are enveloped, which means that they are sensitive to the environment and disinfectants. These viruses are typically transmitted by direct contact. HSV-1 usually affects people in childhood during the first year of life after the disappearance of maternal antibodies that are usually protective.
Infection with any of the viruses is usually asymptomatic. However, clinical features may occasionally be seen, especially on the skin. It usually presents as macular or papular lesions on the skin and mucous membranes. These lesions then progress to form vesicles, pustules, and ulcers (Parra-Sánchez, 2019). These lesions can be painful, and patients may complain of painful inflammatory lesions around the genitalia. In women, pain occurs around the vulva. The disease may also affect the lower urinary tract, and this presents as dysuria and burning pain during urination. Fever and lymphadenopathy may be present, and the disease may ascend to affect the cervix (cervicitis). It can also cause an inflammation of the lining of the rectum.
The laboratory diagnosis of genital herpes is made via direct viral detection. A discrepancy in testing for genital herpes exists. The reason for this is that other diseases, such as chlamydia, may present with the same symptoms as those seen in genital herpes (Roett, 2020). Some clinicians end up diagnosing such patients based on clinical symptoms alone without confirming the diagnosis in the laboratory. Another reason could also be due to the fact that some infected patients are asymptomatic. This means that such patients don’t present to hospitals and healthcare facilities for treatment. These patients, therefore, remain unaccounted for. Another way of testing for genital herpes is via the detection of virus-specific antibodies. The use of antibodies alone for diagnosis is challenging as it is difficult to differentiate between a recent infection and a previous infection. This increases the number of false-positive tests.
To improve testing, I would suggest that a PCR test should be performed to confirm the diagnosis. PCR demonstrates viral genomes from skin or mucosal swabs. Also, serologic tests should not be used for diagnosis but only for confirmation of diagnosis.
Parra-Sánchez M. (2019). Genital ulcers caused by herpes simplex virus. Úlceras genitales por virus herpes simplex. Enfermedades infecciosas y microbiologia clinica (English ed.), 37(4), 260–264. https://doi.org/10.1016/j.eimc.2018.10.020
Roett M. A. (2020). Genital Ulcers: Differential Diagnosis and Management. American Family Physician, 101(6), 355–361.
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It has been stated that the actual number of people in the United States who have genital herpes may be a lot higher than official statistics depict.
Describe what genital herpes is as if you were addressing a potential patient.
Explain how genital herpes affects the human body.
Discuss some possible reasons for this discrepancy in testing.
Given what you know about this type of infection, what would you suggest to improve testing?
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