From the Guidelines
Herpes simplex virus (HSV) is extremely common in the population, with approximately 47.8% and 12.1% of the United States population aged 14–49 years seropositive for HSV-1 and HSV-2, respectively. The prevalence of HSV-1 and HSV-2 varies significantly by geographic region, age, gender, and sexual activity, with women tend to have higher rates of HSV-2 than men, and prevalence increases with age as infections are lifelong 1.
Key Points
- HSV-1 seroprevalence reflects oral and genital infection, but HSV-1 is an increasing cause of first-episode genital herpes, particularly in well-resourced settings 1.
- Genital herpes is unrecognized in most people; in a National Health and Nutrition Examination Survey study, only 13% of HSV-2–seropositive persons had been diagnosed with genital herpes 1.
- Many people with HSV remain asymptomatic, which contributes to its widespread transmission, as individuals may unknowingly spread the virus during periods of asymptomatic viral shedding.
Prevalence
The high prevalence of HSV makes it one of the most common viral infections worldwide, though many infected individuals never develop symptoms or realize they carry the virus.
Transmission
The virus may be present in the genital tract without symptoms, leading to transmission to sex partners or neonates, when present in the genital tract during delivery 1.
Complications
HSV-2 fuels the human immunodeficiency virus (HIV) epidemic, with a 3-fold increased risk of HIV acquisition among persons with HSV-2 infection as compared to those without HSV-2 infection 1.
From the Research
Prevalence of HSV in the Population
- The global burden of HSV-1 infection is estimated to be around 3709 million people aged 0-49 years, with a prevalence of 67% 2.
- The prevalence of HSV-1 infection varies by region, with the highest prevalence in Africa, South-East Asia, and Western Pacific 2.
- Genital HSV-1 infection is estimated to affect around 140 million people, with the majority of cases occurring in the Americas, Europe, and Western Pacific 2.
HSV-1 and HSV-2 Infections
- HSV-1 commonly causes orolabial ulcers, while HSV-2 commonly causes genital ulcers 2.
- However, HSV-1 is an increasing cause of genital infection, and its global burden is substantial 2.
- The treatment of herpes simplex infections, including HSV-1 and HSV-2, can be achieved through antiviral medications such as valacyclovir, acyclovir, and famciclovir 3, 4, 5, 6.
Treatment and Management
- Valacyclovir is an effective drug for the suppression of recurrent episodes of genital herpes in immunocompetent and immunocompromised individuals 3.
- The choice of treatment approach, including intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy, depends on clinical characteristics and patient preference 6.
- Evidence-based dosing regimens for antiviral medications, such as valacyclovir, acyclovir, and famciclovir, are available to guide treatment decisions 4, 6.