From the Guidelines
Having HSV-2 positive immunity means you are a carrier of genital herpes, which can lead to recurrent genital ulcers or blisters, and it is essential to manage the infection to reduce transmission risk and improve quality of life. The clinical significance of having HSV-2 positive immunity is that you are at risk of transmitting the infection to sexual partners, even without symptoms, due to viral shedding 1. According to the 2021 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines, genital herpes can be managed either by episodic antiviral therapy or suppressive antiviral therapy 1.
Management of Genital Herpes
- Antiviral medications like acyclovir, valacyclovir, or famciclovir can help manage outbreaks and reduce their duration 1.
- For frequent recurrences (more than 6 per year), daily suppressive therapy may be recommended 1.
- Using barrier methods during sexual activity and avoiding sexual contact during outbreaks reduces transmission risk 1.
- Informing sexual partners about your HSV-2 status allows them to make informed decisions about protection 1.
Reducing Transmission Risk
- The use of suppressive antiviral therapy, such as valacyclovir 500 mg once daily, can reduce HSV-2 transmission to susceptible heterosexual partners by 50% 1.
- Consistent use of latex condoms can reduce HSV-2 acquisition from women to men and from men to women 1.
- Avoiding sexual contact when partners have overt (genital or orolabial) herpetic lesions is crucial in preventing transmission 1.
Quality of Life
- Many people with HSV-2 remain asymptomatic, while others may experience recurrent genital ulcers or blisters 1.
- HSV-2 remains in the body for life, with the virus establishing latency in nerve ganglia and periodically reactivating, but many people experience fewer and milder outbreaks over time as the immune system adapts 1.
- Patient education on the natural history of infection can help combat stigma associated with genital herpes 1.
From the Research
Clinical Significance of HSV-2 Positive Immunity
- Having HSV-2 positive immunity can significantly reduce the risk of transmitting genital herpes to a partner, as shown in a study where valaciclovir reduced the risk of transmitting HSV-2 infection by 48% 2.
- The risk of clinical disease in the susceptible partner can also be reduced by 75% with valaciclovir therapy 2.
- Innate immunity plays a crucial role in limiting initial viral replication and facilitating an appropriate adaptive immune response during primary and recurrent HSV-2 infections 3.
- Antiviral therapy, such as acyclovir, valacyclovir, and famciclovir, can reduce the morbidity associated with HSV-2 infections and are efficacious and safe for the treatment of the first episode and recurrent genital herpes 4.
- Suppressive antiviral therapy with acyclovir, valacyclovir, or famciclovir can decrease the number of patients with at least one recurrence of genital herpes per year, although the quality of evidence is low due to risk of bias and inconsistency 5.
- Current interventions for HSV-1 and -2 infections consist solely of antiviral chemotherapeutic agents, and numerous experimental vaccines are under consideration 6.
Key Findings
- Valaciclovir can reduce the risk of transmitting HSV-2 infection by 48% and the risk of clinical disease in the susceptible partner by 75% 2.
- Antiviral therapy can reduce the morbidity associated with HSV-2 infections 4.
- Suppressive antiviral therapy can decrease the number of patients with at least one recurrence of genital herpes per year 5.
- Innate immunity plays a crucial role in limiting initial viral replication and facilitating an appropriate adaptive immune response during primary and recurrent HSV-2 infections 3.