HSV2- NHANES Report 200881% of those who tested seropositive for HSV2 in NHANES had not yet received diagnosisSeroprevalence increased with age16.2% seroprevalence rate of HSV2 in ages 14-49Highest rates are in women and non-hispanic blacks
Herpes SymptomsMany people who are infected have no symptoms- especially HSV-2Estimated that 1 in 5 adults have the infectionSymptoms vary widely depending on whether it is an initial or recurrent episode
Initial or Primary HerpesFirst outbreak usually most severeSymptoms worse in women than menFirst outbreak occurs within a few weeks of infection and resolves in 2-3 weeksBlisters (single or multiple) in the genital area that become painfulblisters. May develop new lesions for 5-7 days, then crust over and healMay experience flu-like symptoms
Recurrent HerpesRecurrent outbreaks of blisters/ulcers occur after initial outbreakUsually less severe in duration and intensityUsually in same location, but not alwaysRecurrence is more common with HSV-2 as opposed to HSV-150% experience mild symptoms (itching, tingling) called prodromebefore the lesions appear
HSV SheddingViral shedding means the virus is present in the urinary or genital tractDuring this time there are no ulcers present and infection canbe transmittedShedding occurs 20% of the time (average of 72 days per year) (HSV2)Some people shed virus more than othersHSV2 sheds more than HSV1
HSV DiagnosisHistory of exposure and presence of characteristic signs and symptomsCulture of HSV from an ulcer with a swabOnly detects virus 50% of the time, better on new lesions (<48 hrs old) and better if initial episode of herpesAntibody blood test (serology) - but only 3-4 weeks after initial outbreak
HSV DiagnosisType-specific antibody testing can be beneficial in certain circumstancesSeveral tests are now available and approved- by FDA but are expensiveViral testing by PCR for HSV DNA is not yet cleared by the FDARoutine Screening is notrecommended
HSV Risk Factors and TransmissionTransmitted during oral, anal or vaginal sexIt is possible to develop genital herpes after exposure to a cold sore during oral sex (HSV-1)Transmission can occur without any visible sign of infectionIndividuals with HSV are at increased risk for HIVvia open skin lesions
HSV TreatmentNot curable, but can be managed with antiviral therapy (acyclovir, famciclovir and valacyclovir)Episodic therapy - Treat when symptoms begin for 7-10 days. Usually recommended if have <6 outbreaks /yearSuppressive therapy- Continuous, lower dose therapy (>6 outbreaks/yr). Has been shown to reduce transmission by 50%
Herpes CounselingPotential for recurrence, shedding transmissionSuppressive vs. episodic therapyInform partnersAbstain when lesions are present or prodromeCondoms can decrease transmissionPregnant women require special consideration
HSV and Pregnancy
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- Spring '14
- Sexual intercourse, Human sexual behavior, Oral sex, Human papillomavirus, Sexually transmitted diseases and infections