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The following is taken from the Center for Disease Control and Prevention’s (CDC) website.

Common Questions Regarding the HSV-2 Virus

How common is genital herpes?

Genital herpes infection is common in the United States. CDC estimates that, annually, 776,000 people in the United States get new herpes infections. Nationwide, 15.5 % of persons aged 14 to 49 years have HSV-2 infection.  Approximately 25% of the gay population have HSV-2, however, 87.4% of those 25% don’t even know they have it because they don’t have any symptoms.

HSV-2 infection is more common among non-Hispanic blacks (41.8%) than among non-Hispanic whites (11.3%). This disparity remains even among persons with similar numbers of lifetime sexual partners. For example, among persons with 2–4 lifetime sexual partners, HSV-2 is still more prevalent among non-Hispanic blacks (34.3%) than among non-Hispanic whites (9.1%) or Mexican Americans (13%). Most infected persons are unaware of their infection. In the United States, an estimated 87.4% of 14–49 year olds infected with HSV-2 have never received a clinical diagnosis.

How do people get genital herpes?

Infections are transmitted through contact with lesions, mucosal surfaces, genital secretions, or oral secretions. HSV-1 and HSV-2 can also be shed from skin that looks normal. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission most commonly occurs from an infected partner who does not have visible sores and who may not know that he or she is infected. In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10% of days, and on most of those days the person has no signs or symptoms.

What are the symptoms of genital herpes?

Most individuals infected with HSV-2 are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition. As a result, 87.4% of infected individuals remain unaware of their infection. When symptoms do occur, they typically appear as one or more vesicles on or around the genitals, rectum or mouth. The average incubation period after exposure is 4 days (range, 2 to 12). The vesicles break and leave painful ulcers that may take two to four weeks to heal. Experiencing these symptoms is referred to as having an “outbreak” or episode.

Clinical manifestations of genital herpes differ between the first and recurrent outbreaks of HSV. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache. Recurrent outbreaks of genital herpes are common, in particular during the first year of infection. Approximately half of patients who recognize recurrences have prodromal symptoms, such as mild tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions. Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over time. Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.

What are the complications of genital herpes?

Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. Both HSV-1 and HSV-2 can also cause rare but serious complications such as blindness, encephalitis (inflammation of the brain), and aseptic meningitis (inflammation of the linings of the brain). Development of extragenital lesions in the buttocks, groin, thigh, finger, or eye may occur during the course of infection.

Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. There can be can be considerable embarrassment, shame, and stigma associated with a herpes diagnosis that can substantially interfere with a patient’s relationships. Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define options. Since a diagnosis of genital herpes may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner

What is the link between genital herpes and HIV?

Genital ulcerative disease caused by herpes make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if exposed to HIV when genital herpes is present. Ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum) from a herpes infection may compromise the protection normally provided by the skin and mucous membranes against infections, including HIV. Herpetic genital ulcers can bleed easily, and when they come into contact with the mouth, vagina, or rectum during sex, they may increase the risk of HIV transmission.

How is genital herpes diagnosed?

The preferred HSV tests for patients with active genital ulcers include viral culture or detection of HSV DNA by polymerase chain reaction (PCR). HSV culture requires collection of a sample from the sore and, once viral growth is seen, specific cell staining to differentiate between HSV-1 and HSV-2. However, culture sensitivity is low, especially for recurrent lesions, and declines as lesions heal. PCR is more sensitive, allows for more rapid and accurate results, and is increasingly being used. Because viral shedding is intermittent, failure to detect HSV by culture or PCR does not indicate and absence of HSV infection. Tzanck preparations are insensitive and nonspecific and should not be used.

Serologic tests are blood tests that detect antibodies to the herpes virus. Several ELISA-based serologic tests are FDA approved and available commercially. Older assays that do not accurately distinguish HSV-1 from HSV-2 antibody remain on the market, so providers should specifically request serologic type-specific assays when blood tests are performed for their patients. The sensitivities of type-specific serologic tests for HSV-2 vary from 80-98%; false-negative results might be more frequent at early stages of infection. Additionally, false positive results may occur at low index values and should be confirmed with another test such as Biokit or the Western Blot. Negative HSV-1 results should be interpreted with caution because some ELISA-based serologic tests are insensitive for detection of HSV-1 antibody.

For the symptomatic patient, testing with both virologic and serologic assays can determine whether it is a new infection or a newly-recognized old infection. A primary infection would be supported by a positive virologic test and a negative serologic test, while the diagnosis of recurrent disease would be supported by positive virologic and serologic test results.

CDC does not recommend screening for HSV-1 or HSV-2 in the general population. Several scenarios where type-specific serologic HSV tests may be useful include

  • Patients with recurrent genital symptoms or atypical symptoms and negative HSV PCR or culture;
  • Patients with a clinical diagnosis of genital herpes but no laboratory confirmation;
  • Patients who report having a partner with genital herpes;
  • Patients presenting for an STD evaluation (especially those with multiple sex partners);
  • Persons with HIV infection; and
  • MSM at increased risk for HIV acquisition.

Is there a cure or treatment for herpes?

There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e. daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.

Several clinical trials have tested vaccines against genital herpes infection, but there is currently no commercially available vaccine that is protective against genital herpes infection. One vaccine trial showed efficacy among women whose partners were HSV-2 infected, but only among women who were not infected with HSV-1. No efficacy was observed among men whose partners were HSV-2 infected. A subsequent trial testing the same vaccine showed some protection from genital HSV-1 infection, but no protection from HSV-2 infection.

How can herpes be prevented?

Correct and consistent use of latex condoms can reduce the risk of genital herpes.  However, outbreaks can occur in areas that are not covered by a condom.

The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Persons with herpes should abstain from sexual activity with partners when sores or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.

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