Herpes, Genital

Descriptive text is not available for this image BASICS

DESCRIPTION

  • Chronic, recurrent herpes simplex virus (HSV) type 1 or 2 infection of any area innervated by the sacral ganglia
  • HSV-1 primarily causes anogenital and orolabial lesions; HSV-2 typically causes anogenital lesions, however genital herpes is increasingly being caused by HSV-1
  • 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

EPIDEMIOLOGY

  • Most commonly infected from age 15 to 30 years; prevalence increases with age due to cumulative likelihood of exposure.
  • HSV-2: female > male
  • United States: HSV-1 infectivity highest in Mexican Americans and HSV-2 highest in non-Hispanic African Americans

Incidence

Studies estimate the incidence in the United States to be ~572,000 to 1.6 million new cases per year; highest in 18- to 24-year-olds.

Prevalence

  • 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%, and the prevalence of HSV-2 is ~12%.
  • Up to 90% of those who are seropositive lack formal diagnosis.
  • Globally, it is estimated that HSV-1 infects 3.7 billion people–15 to 49 years old–versus 491 million for HSV-2 representing 67% and 13% of the population respectively.

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, unpredictably, and more commonly with HSV-2.
  • HSV infection increases the risk for HIV.

RISK FACTORS

  • Risk increases with age, number of lifetime partners, history of sexually transmitted infections (STIs—particularly 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, hormonal shifts, sun exposure, dietary intake, and trauma increase the risk of reactivation.

GENERAL PREVENTION

  • Use barrier contraception and avoid sexual contact when symptoms/lesions are present.
  • Abstinence is the only means of complete protection.

COMMONLY ASSOCIATED CONDITIONS

Syphilis, HIV/AIDS, chlamydia, gonorrhea, other STIs

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