Herpes simplex virus type 2 (HSV-2) infects 22% of US adults aged 12 and older, leading to genital herpes. The disease is caused by one of two viruses, with the other causing mouth and lip blisters. One in six individuals aged 14-49 suffers, with women being more susceptible.
Risk Factors
Direct contact with fluids (saliva) from a seropositive person carrying viral products, usually during sexual activity, is one of the risk factors for contracting an HSV-2 infection. The primary way that HSV-2 is spread is through sexual contact, which explains why it is more common after puberty.
Recognizing the first outbreak symptoms:
Usually asymptomatic, orolabial HSV-1 infection can cause cold sores, fever blisters, and pharyngitis in females. The symptoms of a primary orolabial infection usually manifest three days to a week following exposure and include flu-like symptoms during an outbreak such as fevers, painful lymphadenopathy, anorexia, and malaise. Usually, mucocutaneous lesions on the lips and mouth develop into ulcerations, erosions, and pustules.
Genital Sores and Discomfort Explained
Small, blister-like bumps typically appearing in clusters are the initial sign of genital herpes. Usually, 24 to 48 hours before these sores develop, you may feel itchy or tingly in the affected area. The blisters finally burst open and leak, resembling wounds or ulcers.
Recurrent outbreak patterns in women:
Females may experience shorter symptoms in later outbreaks, which often resemble the original outbreak but are milder. These symptoms include: Genital herpes symptoms include sores, a burning sensations during urination, difficulty urinating, and itching. Oral herpes outbreaks are common in the first year, with symptoms including skin flushing, swelling, heat, itching, pain, painful blisters, and leaking blisters turning into sores.
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Diagnosis:
To detect HSV, vesicular lesions must be directly swabbed within 72 hours of commencement to prevent crusting or healing. HSV PCR, tzank smear, direct fluorescent antigen, serotyping, and antibody testing are among the tests. Symptoms that resemble an acute urinary tract infection may warrant a urinalysis and culture. Additional STI workups may involve HIV, RPR, and gonorrhea/chlamydia testing.
Treatment
Treatment for orolabial herpes entails oral valacyclovir; immunocompetent patients are advised to undergo long-term suppression. Treatment for eczema herpeticum consists of 10–14 days of acyclovir or valacyclovir. Oral acyclovir 400–800 mg or valacyclovir 500 mg twice daily are used as part of a chronic suppression treatment for immunocompromised patients with severe and chronic HSV.
Patient education
The following are important educational facts to take into account:
- It is advised to use condoms.
- Avoid having intercourse while there is known ongoing viral shedding (visible lesions).
- If regular sexual activity is anticipated to occur, think about prophylactic suppressive therapy.
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Summary
Although there is no treatment for HSV, suppressive therapy can help stop the virus from spreading to seronegative people. Since HSV has been linked to HIV infection, patients who receive a new HSV diagnosis should undergo comprehensive STI workups. The first person to diagnose and treat HSV-2 infections is frequently the primary care physician or provider. The best way to treat this illness, however, is through an interprofessional team approach.
References
Mathew, J. Jr., & Sapra, A. (2024). Herpes simplex type 2. In StatPearls (Internet). Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554427/.
Saleh, D., Yarrarapu, S. N. S., & Sharma, S. (2024). Herpes simplex type 1. In StatPearls (Internet). Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482197/.
