Herpes Simplex Virus Type 2 (HSV-2): Transmission, Symptoms & Management

Correction: The original title mentions HSV-2 but the content describes HSV-1. Here are accurate facts for HSV-2 (genital herpes).

Transmission

• Sexual contact: vaginal, anal, oral sex with infected partner.
• Asymptomatic shedding: 10–20% of days; major driver of transmission.
• Vertical: during vaginal delivery if active lesions (neonatal herpes).

Clinical Presentation

• Primary Episode: 2–12 days post-exposure. Bilateral painful vesicles/ulcers on genitalia, perineum, buttocks; inguinal lymphadenopathy; fever, malaise, dysuria. Heals in 2–4 weeks.
• Recurrences: Shorter, milder, often unilateral. Prodrome: tingling, burning 12–48 hrs before lesions.
• Asymptomatic: Most infections never recognized.

Diagnosis

• NAAT from lesion swab (gold standard; sensitivity >95%).
• Type-specific serology (IgG to gG-2): confirms past infection; not for acute diagnosis.

Management

• Episodic Therapy: Valacyclovir 1 g BID ×5 days (start at prodrome).
• Suppressive Therapy: Valacyclovir 500 mg daily (or 1 g daily if frequent recurrences). Reduces recurrences 70–80%, transmission ~50%.
• Counseling: Disclosure, condom use (partial protection), avoid sex during outbreaks.
• Pregnancy: Suppressive therapy from 36 wk if history; C-section if active lesions at labor.

Key Points

• HSV-2 is lifelong; latency in sacral ganglia.
• Stigma often exceeds medical morbidity.
• No cure; effective control achievable.