Herpes Simplex Virus

Abstract

Genital herpes is one of the most common sexually transmitted diseases globally, and is associated with significant physical and psychological morbidity. However, upwards of 90% of infected individuals are unaware they are infected. Genital herpes is caused by herpes simplex virus type 1 (HSV-1) or herpes simplex type 2 (HSV-2). While there are differences between HSV-1 and HSV-2, both strains can cause ocular, oral, cutaneous and genital infections. HSV must come in contact with mucosal surfaces or abraded skin to initiate infection. Once infected, HSV persists indefinitely in a dormant state within sensory nerve ganglia until it is reactivated and causes a recurrent infection (Herpes simplex virus infections. 2. 2nd ed. Detroit: Charles Scribners & Sons; 2010. p. 823–828; Groves Am Fam Physician 93(11):928, 2016; Solomon et al. N Engl J Med 375(7):666, 2016; Bernstein et al. Clin Infect Dis 56(3):344–51, 2013) The herpes virus typically causes painful ulcerations at the site of infection, but these lesions do not have to be present to transmit the infection (asymptomatic shedding). On the basis of clinical examination, it is often impossible to determine definitively whether a first symptomatic episode of genital herpes is initial or recurrent disease. There are several different modalities to test for HSV infection, but PCR has emerged as the most reliable and sensitive method to confirm infection. A primary episode of HSV should be treated with oral antiviral therapy to prevent prolonged clinical illness with severe genital ulcerations. Prevention of genital HSV should primarily focus on decreasing overall HSV transmission and decreasing the morbidity and psychological stress for those already infected.