Sexual Health | Genital ulcer disease | Genital Herpes: Natural History and Complications

Genital Herpes: Natural History and Complications
Session Overview
Description
This session will cover the natural history and complications of genital herpes virus infections.

Learning Objectives
By the end of this session you will be able to:

• Describe the epidemiology of HSV infections
• Identify the natural history of genital HSV infection
• Describe the impact of pre-existing HSV-1 on genital HSV-2 infection
• Explain the concept of viral latency
• Describe the frequency and significance of asymptomatic and unrecognised genital HSV shedding
• Identify the range of genital HSV reactivation and associated factors
   

Prerequisites
Before commencing this session you should complete sessions:

• HIV-STI 01 - Approach to Patient/Sexual History (260-0004)
• HIV-STI 01 - Approach to Patient/Male Genital Examination (260-0009)
• HIV-STI 01 - Approach to Patient/Female Genital Examination (260-0010)

Genital herpes infections may be caused by either Herpes Simplex Virus Type 1 or 2 (HSV-1 or HSV-2). The changing patterns of HSV-1 acquisition in childhood have meant that many individuals will acquire this disease in adult life when at least one third of such late infections will involve the genital area. In many parts of the world HSV-1 is the principal type of HSV for acquisition episodes. However, the majority of cases of frequent and severe genital disease remain due to HSV-2.

After the initial infection of the mucocutaneous surface, the herpes virus establishes latency in the dorsal root ganglion. The virus reactivates from time to time resulting in either a mucocutaneous outbreak or asymptomatic shedding. It is estimated that up to 70% of all genital HSV-2 is transmitted during asymptomatic shedding from a source partner with HSV-2. Counselling regarding the chronic, recurrent nature of the infection and methods to reduce transmission are integral to patient management.