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Herpes, Genital

Herpes, Genital is a topic covered in the 5-Minute Clinical Consult.

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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).
  • Up to 90% of seropositive persons lack formal diagnosis.
  • >50 million are infected with HSV-2 in the United States.

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 since precautions may not be followed (abstinence, condom use). 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 increases the risk of being infected with HSV-2 by 3-fold.
  • Immunosuppression, fever, stress, and trauma increases risk of reactivation.

Commonly Associated Conditions

Syphilis, HIV, chlamydia, gonorrhea, and other STIs

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Stephens, Mark B., et al., editors. "Herpes, Genital." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116276/all/Herpes__Genital.
Herpes, Genital. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116276/all/Herpes__Genital. Accessed April 18, 2019.
Herpes, Genital. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116276/all/Herpes__Genital
Herpes, Genital [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116276/all/Herpes__Genital.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Herpes, Genital ID - 116276 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116276/all/Herpes__Genital PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -