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HSV-2 Infections

HSV-2 primary infection

The characteristics of primary genital herpes infection range from no noticeable symptoms to tingling and numbness in the legs (lower extremities) and lower part of the body between the genitals and anus (perineum), painful genital ulcers, painful urination, and tender lymph nodes in the groin. Primary genital herpes can also include fever, malaise, and headache. Symptoms may last for several weeks before healing.

Female genitalia

Local symptoms are often more severe in women than in men and may include irritated and inflamed vulval and/or vaginal areas (vulvovaginitis) with blisters which will develop into painful ulcers. The rectal area may also be inflamed or contain blisters.

Male genitalia

The tip or the shaft of the penis and/or rectal area may have inflamed blisters and ulcers.


Occasionally, primary HSV-2 infection can lead to inflammation of the membranes of the brain or spinal cord (meningitis) or to retention of urine in the bladder. Such complications have been reported to be somewhat more common in women.

HSV-2 recurrent infection

Not all HSV-2 infected patients will suffer from recurrent genital herpes. If reactivation results in clinical symptoms, it is more limited than in primary infection with fewer and more localized lesions, less inflammation, and quicker healing. Recurrent genital herpes may even occur as a limited patch of blisters on the buttock or on the loins.

Complications. Recurrent HSV-2 infection may, in rare instances, occur as recurrent meningitis (Mollaretís meningitis), which is a self limiting condition. It may also appear as recurrent numbness and tingling in the lower extremities and, rarely, in paralysis of the bladder and the lower extremities (transverse myelitis).

Viral shedding or asymptomatic infection

HSV-2 can reactivate from its dormant state without producing clinical symptoms and result in viral shedding. Studies have shown that this may occur in almost 40% of HSV-2 infected people. Viral shedding occurs over a 1-5 day period. As there are no symptoms associated with this phenomenon, the patient will be unaware of it. We only know the average duration of each period of viral shedding through laboratory studies, where volunteers have been monitored for virus over long periods of time.

Sexual partners may become infected during episodes of asymptomatic shedding, as the infected person is unaware of the shedding and may not take any precautions against transmission.

Recurrent genital herpes summary:
  • Classically a group of small blisters(vesicles) occurs on a patch of red skin
  • Sometimes the outbreak is so minor as to be seemingly asymptomatic. This occurs in about a quarter of cases
  • Local irritation or cracking of the skin may be the only sign of a recurrence
  • Viral shedding usually lasts for 1-5 days. This is an infectious period
All recurrent HSV infections summary:
  • Recurrence rates for oral and genital herpes varies a great deal. The outbreaks may be as often as monthly in 25% of sufferers
  • HSV-1 recurs more often than HSV-2 in the oral area
  • HSV-2 recurs more often than HSV-1 in the genital region

Transmission risk

Approximately 40 million to 60 million Americans are infected with dormant HSV-2, and the number of new infections each year has been estimated at 500,000. The seroprevalence of HSV-2 increases from approximately 6% at 12-19 years of age to approximately 30% by the age of 30-39 years.

U.S. studies show that the risk of acquiring genital herpes increases with the number of sexual partners. For heterosexual women living with one partner, the risk of contracting HSV-2 is 10%. This risk increases to 40%, 62% and more than 80% as the number of life time partners increases to 2-10, 11-50, or more than 50, respectively. For heterosexual men, there is zero probability for acquiring HSV-2 with just one life time sexual partner, and a 20%, 35%, and 70% risk for those in each of the other 3 risk groups. For homosexual men, seroprevalence increases from more than 60% to 90% for those with 11-50 partners and those with more than 50 partners.

Women have higher rates of infection than men; the estimated risk of susceptible females contracting HSV from infected males is 80% following a single contact. Among college students, the rate of acquisition is 2% per year, compared with an annual rate of 4% for homosexual men. As HSV-2 infection is an ulcerative disease, it increases the risk of acquisition of HIV by 1.5-2.0.

Viral transmission
  • It is thought that in 70% of cases, genital herpes is transmitted by sexual contact from a person who has asymptomatic shedding of the virus