Definition

Genital herpes in men is a herpes virus infection that causes symptoms such as sores or rashes on the male genitals. This disease is classified as a sexually transmitted infection (STI) that is relatively common, with about 8.2% of men aged 14-49 years suffering from genital herpes.

Due to the anatomical structure and reproductive tract of men, certain complications of genital herpes only occur in men. Genital herpes can also occur in women.

Causes

Genital herpes is caused by the herpes simplex virus (HSV), and there are two types of HSV:

1. Herpes simplex virus type 1 (HSV-1)
• Can spread through mouth contact and cause herpes infections in the mouth.
2. Herpes simplex virus type 2 (HSV-2)
• This virus generally spreads through sexual contact.

Both types of these viruses are found on the skin, saliva, and genital secretions. The virus can easily spread through sexual contact, usually when someone does not use protection (condoms) during sexual intercourse with a person who has herpes. Sexual contact can include contact with the vagina, anus, or mouth of the infected person.

You can get genital herpes if you come into contact with:

• Herpes sores.
• Saliva from a partner who has oral herpes.
• Genital secretions from a partner who has genital herpes.
• Skin around the mouth or genitals of a person infected with herpes.

Transmission can also occur even if the infected person is asymptomatic or unaware that they have herpes.

Risk factor

The following factors can increase a person's risk of developing genital herpes:

• Sexual contact with someone who has HSV-1 or HSV-2.
• Engaging in sexual activity without using protection (condoms).
• Frequently changing or having multiple sexual partners.
• History of sexually transmitted infections (STIs).
• Having medical conditions that lower the immune system (HIV infection, etc.).

Symptoms

Genital herpes symptoms tend to appear suddenly, usually around 2-12 days (average 4 days) after exposure to the herpes simplex virus. Most people infected do not show symptoms, or the symptoms are so mild that they are unaware they are infected. You might not know you have herpes until you transmit it to someone else or get tested.

Symptoms and complaints that can arise from genital herpes in men include:

• Red spots filled with fluid or small blisters around the genitals or anus.
• Spots that burst will release fluid or blood, and can cause painful sores or scabs.
• Itching or sharp pain in the genital area.
• Pain or burning sensation when urinating.
• Flu-like symptoms, such as joint and muscle pain, headaches, or fever.
• Swollen lymph nodes in the groin.
• Sores or scabs can take about 2-4 weeks to heal after the initial infection. The complaints from genital herpes infections can also vary from the first attack to subsequent episodes. Generally, the duration of sores and skin lesions in the first herpes attack is longer. Complaints that appear during recurrent episodes of the disease will decrease over time.

The location of genital herpes can vary for each man. Besides the penis and scrotum (scrotal skin), herpes is also often found around the foreskin (prepuce).

Diagnosis

Interview and Physical Examination

The doctor will ask in detail about your symptoms, your previous medical history, and the treatments you have undergone. The doctor can also inquire about sexual behavior and look for STI risks in the patient. The doctor will examine the skin abnormalities or sores.

Diagnostic Examination

Since genital herpes is one of the sexually transmitted infections, the doctor can conduct blood tests to see if the patient has other infections like HIV or syphilis. For spots or blisters that release fluid, fluid samples can be taken for further examination to find out if the skin abnormalities are caused by the virus.

There is also a swab test that can help diagnose genital herpes, which includes:

• Viral culture: a test technique using fluid or tissue samples to culture microbes and see if the suspected virus will grow.
• Nucleic acid amplification test (NAAT): this test can identify specific viruses like HSV-1 or HSV-2 by amplifying the viral genetic material.

In addition to the swab test, there is a blood test called enzyme-linked immunosorbent assays (ELISA) that can detect immune proteins called antibodies specific to HSV-1 and HSV-2. This test is useful if you have been exposed to genital herpes through sexual contact but do not have symptoms.

Differentiating HSV-1 from HSV-2 can help determine the treatment plan because genital herpes caused by HSV-2 is more likely to recur compared to that caused by HSV-1.

Management

Genital herpes cannot be cured, but there are treatments that can help control the symptoms. Antiviral drugs can help prevent the virus from continuing to reproduce, shorten the illness period, and reduce the number of recurrent episodes you experience. Medications can also reduce the risk of transmitting the virus to others. The dosage and duration of treatment for genital herpes can vary depending on the symptoms that appear, whether this is the first time the symptoms have been felt or they have often recurred.

For some people, taking medication when symptoms appear is sufficient. However, people with frequently recurring herpes might need to take low-dose antivirals regularly to suppress the virus levels in the body. This therapy is aimed at preventing recurrence and reducing the likelihood of transmission to a partner.

To relieve pain and itching, you should keep the genital area as clean as possible during an episode. You can also apply a cold compress several times a day.

Complications

Genital herpes infection can cause complications such as:

• Higher risk of contracting STIs.
• Meningitis (inflammation of the brain membranes) can occur in rare cases.
• Proctitis, an inflammatory condition of the rectal mucosa, often found in men who have sex with men.

Prevention

Proper and consistent use of latex condoms can reduce the risk of virus transmission, although it does not completely eliminate the risk of genital herpes transmission. This is because the virus can spread to areas not covered by the condom.

The most certain way to avoid STI transmission, including genital herpes, is to avoid sexual contact or only be in a relationship with one partner who does not have STIs. You and your partner can routinely get tested for sexually transmitted infections.

Also, avoid skin contact and sexual contact with people with herpes, especially when they are in an episode or experiencing symptoms.

When to see a doctor?

Genital herpes does not always cause symptoms, so it is better to get regular check-ups if you are sexually active. If you have suspicious sores or skin lesions in your genital area, it is advisable to consult a doctor for further information.

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