Herpes Simplex Virus Type 2 (HSV-2): Risks, Complications, and Prevention

Overview

HSV-2 is a sexually transmitted infection causing recurrent genital ulcers. Primary infection may be asymptomatic or present with painful vesicles, lymphadenopathy, and systemic symptoms.

Complications

• Neonatal herpes: Vertical transmission during delivery (risk 30–50% if primary maternal infection near term). Causes encephalitis, disseminated disease, death. Cesarean indicated if active lesions/prodrome at labor.
• HSV encephalitis/meningitis: Rare but life-threatening; HSV-1 more common cause, but HSV-2 can cause recurrent meningitis (Mollaret's).
• HIV acquisition: Genital ulcers increase HIV susceptibility 2–4 fold.
• Psychosocial impact: Stigma, anxiety, sexual dysfunction.

Management

• Episodic therapy: Valacyclovir/acyclovir/famciclovir at outbreak onset.
• Suppressive therapy: Daily antiviral reduces outbreaks 70–80% and asymptomatic shedding ~50%; reduces transmission to partners.
• Counseling: Disclosure, condom use, avoiding sex during prodrome/outbreaks.

Prevention

• Condoms (reduce but don't eliminate risk—viral shedding occurs in uncovered areas).
• Suppressive therapy in discordant couples.
• No vaccine currently available.

HSV-2 is not fatal in immunocompetent adults but causes significant morbidity and neonatal risk.