Genital herpes – colloquially called genital herpes – (synonyms: Genital herpes; HSV-2; HSV-II; herpes simplex; herpes simplex genitalis; herpes urogenitalis; herpes viruses; herpes virus infection; ICD-10-GM A60. 0: Infection of the genital organs and genitourinary tract by herpes viruses) is a chronic, lifelong persistent (ongoing) viral disease that results in most cases from primary infection with herpes simplex virus (HSV) type 2, sometimes with herpes simplex virus (HSV) type 1 (in about 30% of cases). After infection, the viruses hide in ganglia (nerve nodules) and can be reactivated for life. The virus is from the Herpesviridae family. It is a pathogen from the group of DNA viruses. The herpes simplex virus type 2 (HSV-2) predominantly causes genital herpes and herpes neonatorum (neonatal herpes). The disease belongs to the sexually transmitted diseases (STD) or STI (sexually transmitted infections). Humans are currently the only relevant reservoir of the pathogen. Occurrence: The infection occurs worldwide. Transmission (route of infection) of the HSV-2 type occurs sexually and perinatally (during birth), as a so-called smear infection, while the HSV-1 type is transmitted orally through saliva (droplet infection). The entry of the pathogen occurs parenterally (the pathogen does not penetrate through the intestine), i.e. in this case, it enters the body through the skin (slightly injured skin; percutaneous infection) and through the mucous membranes (permucous infection). The incubation period (time from infection to onset of disease) for primary infection with HSV-2 is usually between 3-7 days and for primary infection with HSV-1 between 2-12 days. The duration of infectivity (contagiousness) in terms of asymptomatic viral shedding depends on the type of virus: approximately 80-90% of all HSV-2 infected individuals show intermittent shedding of the virus on the genital mucosa (mucosa) on approximately 20% of days. Even HSV-1-seropositive patients may show asymptomatic viral shedding after previous manifest genital herpes. This explains that the majority of sexual transmissions (transmissions) of HSV occur during the asymptomatic phases. Peak incidence: Herpes simplex virus type 2 (HSV-2) transmission begins after puberty. In adulthood, 10-30% of the population (worldwide) is infected. The tendency is increasing. Herpes simplex virus type 1 (HSV-1) appears already in childhood. In adulthood more than approx. 90 % of the population (in Germany) are infected. The seroprevalence (percentage of positive tested serological parameters (here: HSV) at a certain point in time in a certain population) shows in the USA approx. 58 % for HSV-1 and 16 % for HSV-2. Course and prognosis: Genital HSV-1 infection results in a more clinically pronounced onset but fewer recurrences (recurrence of disease) compared to HSV-2 (HSV-1 recurrences: approximately 60%; HSV-2 recurrences: approximately 90%).In more than 90% of cases, the primary infection is asymptomatic (without symptoms). In otherwise healthy individuals, the course of infection is favorable and the disease heals spontaneously (on its own). On average, genital HSV-1 infections have about 1.3 recurrences (relapses) per year, while HSV-2 infected patients can be expected to have about 4 recurrences per year.If maternal (mother’s) primary infection occurs in the last 4 weeks before birth, the neonatal risk of infection (of the newborn) is about 40-50%; in the first trimester (third trimester of pregnancy), the neonatal risk of infection is only 1%. In children and people with immunodeficiency (immune deficiency), the infection can spread to the entire body (herpes sepsis) and may become life-threatening. Notice. In case of infection with HSV-2, a 3-fold increased risk of HIV infection has been described. Vaccination: A vaccination against herpes simplex viruses is not yet available, but is in development.
