Genital Herpes

Clinical Presentation:

Genital herpes is a chronic, lifelong infection caused by herpes simplex virus (HSV) type 1 and type 2. Most cases of recurrent genital herpes are caused by HSV-2. Many persons with genital herpes have mild or unrecognized infections but intermittently shed the virus in the genital tract. When the ulcers do occur, they appear typically as one or more blisters on or around the genitals, rectum, or mouth. The blisters break, leaving tender ulcers that may take 2-4 weeks to heal the first time they occur. Other symptoms, such as fever, headache, muscle aches, malaise, and swollen lymph glands, may occur before appearance of the lesions. After the first episode of genital herpes, symptoms usually recur, but they tend to be milder and briefer. After the lesions erupt, they typically heal in 6-10 days.

Neonatal herpes is a rare but serious condition occurring among infants exposed to HSV during birth. Although the disease may be limited to skin, eyes, or mucus membranes, disseminated disease involving the lungs, liver, adrenal glands, and central nervous system disease (encephalitis), may also occur and are associated with serious consequences.

Diagnostic Testing:

Isolation of HSV in cell culture or nucleic acid amplification tests such as polymerase chain reaction (PCR) are the preferred tests in persons with genital lesions; however, the sensitivity of the culture is low, especially for recurrent lesions. Viral culture isolates can be typed to determine if HSV-1 or HSV-2 is the cause of the infection.  PCR for HSV DNA is considered more sensitive, and results are available sooner, than viral culture³.

Type-specific serologic tests may be useful:

• in clinical diagnosis of genital herpes without laboratory confirmation;
• for recurrent genital symptoms or atypical symptoms with negative HSV culture;
• when a sex partner has known genital herpes.

References

3. Stauffer WM, Painter J, Mamo B, et al. Sexually transmitted infections in newly arrived refugees: is routine screening for Neisseria gonorrheae and Chlamydia trachomatis infection indicated? Am J Trop Med Hyg 2012;86(2):292-5.