Herpes, Genital

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  • Chronic, recurrent herpes simplex virus (HSV) type 1 or 2 infection of any area innervated by the sacral ganglia
  • HSV-1 causes anogenital and orolabial lesions.
  • HSV-2 causes anogenital lesions.
  • Primary episode: occurs in the absence of preexisting antibodies to HSV-1 or HSV-2 (may be asymptomatic)
  • First episode nonprimary: initial genital eruption; preexisting antibodies are present.
  • Reactivation: recurrent episodes
  • Synonym(s): herpes genitalis


  • Most commonly infected from age 15 to 30 years; prevalence increases with age due to cumulative likelihood of exposure.
  • Predominant sex: female > male
  • Predominant race: non-Hispanic blacks

>700,000 new cases per year in the United States

  • Overall prevalence of HSV-2 is 10–40% in the general population and up to 60–95% in the HIV-positive population (1).
  • Between the ages of 14 and 49 years, the prevalence of HSV-1 in the United States is ~48%. The prevalence of HSV-2 ~12%. The prevalence of HSV-1 was highest (72%) in Mexican Americans and HSV-2 was highest (35%) in non-Hispanic blacks.
  • Up to 90% of those who are seropositive lack formal diagnosis.
  • Globally, it is estimated that 3.7 billion people are infected with HSV-1 and 140 million with HSV-2.

Etiology and Pathophysiology

  • HSV is a double-stranded DNA virus of the Herpetoviridae family (1).
  • Spread via genital-to-genital contact, oral-to-genital contact, and via maternal–fetal transmission (2)
  • Incubation is 4 to 7 days after exposure.
  • Risk of transmission highest when lesions are present
  • Viral shedding is possible in the absence of lesions, increasing the risk of transmission (precautions—abstinence, condom use—may not be followed). Viral shedding occurs intermittently and unpredictably.
  • HSV infection increases the risk for HIV.

Risk Factors

  • Risk increases with age, number of lifetime partners, history of sexually transmitted infections (STIs), history of HIV, sexual encounters before the age of 17 years, and partner with HSV-1 or HSV-2.
  • Infection with HSV-1 confers 3-fold risk of infection with HSV-2.
  • Immunosuppression, fever, stress, and trauma increase risk of reactivation.

Commonly Associated Conditions

Syphilis, HIV, chlamydia, gonorrhea, and other STIs

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