Herpes, Genital

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

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  • Genital herpes is a lifelong recurrent infection
  • ∼1 in 4 Americans older than age 30 are seropositive for herpes simplex virus type 2 (HSV-2):
    • Most are asymptomatic
  • 1st episode/primary HSV infection:
    • 2–12 day incubation
    • Symptoms peak 8–10 days after onset
    • Lesions heal in 3 wk
    • Primary infection may have more prominent clinical syndrome and complications (e.g., encephalitis, meningitis, hepatitis)
    • Primary infection may also go unnoticed:
      • >50% of 1st recognized signs and symptoms are not primary infection
  • Recurrent HSV infection:
    • Average patient has 4 recurrences per year, by herpes simplex virus type 1 (HSV-1) recurs less than HSV-2
    • Virus reactivated from dorsal root ganglia
    • Triggered by local trauma, emotional stress, fever, sunlight, cold or heat, menstruation, or infection
    • Milder clinical syndrome and fewer lesions that usually heal within 10 days
  • Asymptomatic HSV infection:
    • Virus is shed intermittently and often transmitted by persons who are without lesions or symptoms


  • 70–90% caused by a DNA virus HSV-2:
    • Remainder caused by HSV-1
  • Increasing prevalence of genital HSV-1 infection:
    • Higher rates of oral sex
    • Falling incidence of childhood (nonsexual) transmission owing to improved social conditions resulting in a larger pool of susceptible adolescents and adults
  • Primary genital infection by HSV-1 is similar to HSV-2 in symptoms and duration, but recurs much less frequently
  • Acquisition of HSV-2 in patients with pre-existing HSV-1 infection is less commonly associated with systemic symptoms:
    • Acquisition of HSV-1 in persons with pre-existing HSV-2 infection is rare
  • HSV vaccines unsuccessful to date, research is ongoing
  • High association with HIV and other STDs

  • Contact isolation and universal precautions should be maintained
  • Patients with HIV coinfection have higher HIV viral levels in the blood and skin lesions during HSV recurrence

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