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Herpes Simplex (HSV)

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Herpes Simplex is a life-long incurable viral infection and is one of the most common sexually transmitted diseases


Viruses have highly variable complex DNA/RNA structure, which account for the different strains within the same family of viruses.  It is highly contagious and can be passed on even when there are no apparent symptoms. 

Sexual health guide - Herpes simplex (HSV)
Herpes Simplex virus (HSV)

Clinical diagnosis is sometimes difficult as patients do not always present with lesions.  It is estimated that while more than one in five Americans older than the age of 12 (50 million) are infected with genital herpes 80% are unaware of the infection.


The etiology of genital herpes is the herpes simplex virus of which there are two strains: Type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but differ in epidemiology.  

Infections may be primary or non-primary and disease episodes may be initial or recurrent.


Herpes simplex virus Infection may be primary or non-primary. Disease episodes may be initial or recurrent (figure 1) and symptomatic or asymptomatic. It is likely that the majority of infections are acquired subclinically as at least 80% of persons seropositive for HSV type-specific antibodies are unaware of that they have been infected.

  • Prior infection with HSV-1 modifies the clinical manifestations of first infection by HSV-2 1.

  • After childhood, symptomatic primary infection with HSV-1 is equally likely to be acquired in the genital area or oral areas 2,2A.

  • Primary genital herpes in the UK is equally likely to be caused by HSV-1 as by HSV-2.

  • Following primary infection, the virus becomes latent in local sensory ganglia, periodically reactivating to cause symptomatic lesions or asymptomatic, but infectious, viral shedding.

  • The median recurrence rate after a symptomatic first episode is 0.34 recurrences/ month for HSV-2 and is four times more frequent than the recurrence rate for HSV-13. Recurrence rates decline over time in most individuals, although this pattern is variable 4.

  • The majority of individuals found to be seropositive for HSV-2 type-specific antibodies subsequently develop symptomatic lesions 5. In some of these individuals, the number of days when virus is shed asymptomatically exceeds the number of days of symptomatic shedding associated with lesions. Virus can be shed asymptomatically from the external genitalia, the anorectum, the cervix, and urethra.

  • In HIV positive HSV-2 seropositive individuals, both symptomatic and asymptomatic shedding are increased, especially in those with low CD4 counts and those who are also seropositive for HSV-16,7.


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