Herpes, Genital
Basics
Description
Description
- Genital herpes is a lifelong recurrent infection
- Two types of HSV can cause genital herpes: HSV-1 and HSV-2
- Most cases of recurrent genital herpes are caused by HSV-2
- There is an increasing proportion of HSV-1 anogenital herpetic infections
- ∼50 million persons in the U.S. are infected with HSV-2
- Most reported cases involve the age groups between 16–40 yr
- Genital herpes simplex virus (HSV) infections are designated as primary, nonprimary first episode, recurrent, asymptomatic
- Primary HSV infection:
- Refers to infection in a patient without preexisting antibodies to HSV-1 or HSV-2
- Average incubation period after exposure is 4 d (range 2–12 d)
- Nonprimary first episode:
- Refers to acquisition of genital HSV-1 in a patient with preexisting antibodies to HSV-2 or vice versa
- Associated with fewer lesions and less symptoms than primary infection
- Antibodies against one HSV type offer some protection against the other
- Recurrent HSV infection:
- Refers to reactivation of genital HSV in which the HSV type recovered in the lesion is the same type as antibodies in the serum
- Duration of lesions is shorter than with primary infection (10 vs. 19 d)
- Symptoms can be less severe; genital lesions may be asymptomatic, fewer in number, atypical in appearance
- Duration of viral shedding is shorter than primary infection (2 vs. 9 d)
- Asymptomatic HSV infection:
- Virus is shed intermittently and often transmitted by persons who are without lesions or symptoms
- Asymptomatic shedding of HSV from the genital tract is most common source of transmission of infection
Etiology
Etiology
- 70–90% caused by a DNA virus HSV-2:
- Remainder caused by HSV-1
- Infection with HSV-1 generally occurs in the oropharyngeal mucosa:
- Trigeminal ganglion becomes colonized; harbors latent virus
- Increasingly more common to detect evidence of HSV-1 in the genital tract, usually due to oral–genital sex
- Recurrences of HSV-1 in the genital tract uncommon
- Acquisition of HSV-2 infection is usually the consequence of transmission by genital contact:
- Virus replicates in the genital, perigenital, or anal skin sites:
- Latent virus in sacral ganglia
- HSV-2 can also infect the mouth:
- Recurrences at this site uncommon
- Virus replicates in the genital, perigenital, or anal skin sites:
- HSV vaccines unsuccessful to date, research is ongoing
- High association with HIV and other STDs
ALERT
- Contact isolation and universal precautions should be maintained
- Those infected with HSV-2 are 2–3 times more likely to acquire HIV:
- Patients who test positive for HSV-2 should also be tested for HIV
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Herpes, Genital." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307122/all/Herpes__Genital.
Herpes, Genital. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307122/all/Herpes__Genital. Accessed December 7, 2024.
Herpes, Genital. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307122/all/Herpes__Genital
Herpes, Genital [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307122/all/Herpes__Genital.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Herpes, Genital
ID - 307122
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307122/all/Herpes__Genital
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -