Genital Herpes

HSV-2 primarily spreads through direct sexual contact with infected individuals. Transmission can occur even without visible symptoms due to asymptomatic viral shedding, making it difficult to control at a population level. The virus is present in clear fluid within vesicular lesions, and contact with this fluid significantly increases transmission risk.

Primary HSV-2 infection typically causes painful vesicular lesions on the genitals and anal area, appearing within 4 to 7 days after exposure. More severe primary infections may include systemic symptoms such as fever, malaise, dysuria, and lymphadenopathy. When vesicles rupture, they form ulcers containing infectious viral particles.

After primary infection, HSV-2 travels to sensory neurons in the sacral dorsal root ganglia, where it establishes latency. The virus persists in a transcriptionally silent state but can reactivate in response to physical or emotional stress, fatigue, immune suppression, or hormonal fluctuations, leading to recurrent outbreaks.

Primary HSV-2 infections are usually more severe than recurrent episodes because the immune system, particularly cell-mediated responses, develops control over viral replication during the initial infection. Host immunity limits the frequency of relapses and reduces outbreak severity. Recurrence patterns vary among individuals based on immune competence and triggering factors.

Genital herpes diagnosis is confirmed using polymerase chain reaction (PCR), viral culture, or serological testing for HSV-specific antibodies. PCR is the most sensitive method and is preferred in clinical practice for accurate identification of HSV-2 infection and distinguishing it from other viral infections.

In immunocompromised individuals, HSV-2 infections can be more severe and disseminated. Genital herpes also increases susceptibility to other sexually transmitted infections, particularly HIV, because mucosal disruption and inflammatory environment facilitate viral entry. Antiviral therapies reduce outbreak severity but do not eradicate latent virus.

Suppressive therapy with daily antivirals such as acyclovir, valacyclovir, and famciclovir decreases recurrence frequency and lowers the risk of transmission to sexual partners. While these therapies reduce the severity and duration of outbreaks, they do not eradicate the latent virus, making ongoing suppressive therapy an important public health strategy.