Herpes simplex type 2 (HSV-2); human herpesvirus 2
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Introduction
Also see Herpes simplex.
Epidemiology
- less prevalent than HSV-1
- overall serologic prevalence in USA is 25%
- higher prevalence in HIV patients
- risk of vertical transmission to fetus
- 30-50% with 1st episode
- risk is < 3% with recurrent Herpes
- highest (3%) with active lesions
- cofactor in transmission of HIV
- most common sexually transmitted ulcerative disease
- transmission occurs through direct contact with infected secretions of skin lesions
Pathology
Clinical manifestations
- primarily associated with genital lesions
- gluteal & presacral lesions also occur
- sacral lesions may occur with aseptic meningitis
- gluteal & presacral lesions also occur
- only 20% of seropositive individuals recall symptoms
- thus partner of affected individual may be asymptomatic
- itching & burning characteristic of prodrome[1]
- recurrent rash is common
- usually presents as a cluster of painful pink papules that rapidly become vesicular
- vesicle is primary lesion of herpes simplex
- in immunosuppressed patients, nodules or nonhealing ulcers
- fissure is atypical presenting feature[1]
- painful genital ulcers, fever, inguinal lymphadenopathy, headache may be noted[1]
- sacral radiculopathy, transverse myelitis, meningitis
* images[10]
Laboratory
- confirm diagnosis with
- Herpes simplex virus 2 glycoprotein G IgG Ab
- Herpes simplex virus 2 Ag in tissue
- see Herpes simplex
- see ARUP consult[8]
Differential diagnosis
- papillomavirus
- molluscum contagiosum
- HIV infection
- fungal infection, Candida
- bacterial infection
- follicular abscess
- hidradenitis suppurativa
- vulvular dystrophy
- cancer of the vulva
Management
- see Herpes simplex
- chronic daily valacyclovir 500 mg PO QD may reduce risk of sexual transmission[2]; VAMC dose is 500 mg BID
- 1% tenofovir gel used intravaginally before & after sex reduces incidence of HSV2 by ~ 50%[9]
- condoms useful for prophylaxis[4]
- viral shedding with potential of transmission to others occurs even in asymptomatic individuals[1]
- genital shedding of HSV2 twice as high when symptomatic[6]; corollary: genital shedding of HSV2 occurs in asymptomatic patients
- even high-dose antivirals do not eliminate viral shedding[7]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 2.0 2.1 Journal Watch 24(4):31, 2004 Corey L et al Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 350:11, 2004 PMID: https://pubmed.ncbi.nlm.nih.gov/14702423
- ↑ Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003
- ↑ 4.0 4.1 Wald A et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med 2005 Nov 15; 143:707-13 PMID: https://pubmed.ncbi.nlm.nih.gov/16287791
- ↑ Corey L. Synergistic copathogens--HIV-1 and HSV-2. N Engl J Med. 2007 Feb 22;356(8):854-6 PMID: https://pubmed.ncbi.nlm.nih.gov/17314346
- ↑ 6.0 6.1 Tronstein E et al Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons With HSV-2 Infection. JAMA. 2011;305(14):1441-1449 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/21486977 <Internet> http://jama.ama-assn.org/content/305/14/1441.short
- ↑ 7.0 7.1 Johnston C et al Standard-dose and high-dose daily antiviral therapy for short episodes of genital HSV-2 reactivation: three randomised, open-label, cross-over trials The Lancet, Early Online Publication, 5 January 2012 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/22225814 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61750-9/fulltext
Van de Perre P and Nagot N Herpes simplex virus: a new era? The Lancet, Early Online Publication, 5 January 2012 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/22226046 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61614-0/fulltext - ↑ 8.0 8.1 ARUP Consult: Herpes Simplex Virus - HSV The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/herpes-simplex-virus
- ↑ 9.0 9.1 Abdool Karim SS et al Tenofovir Gel for the Prevention of Herpes Simplex Virus Type 2 Infection. N Engl J Med 2015; 373:530-539. August 6, 2015 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26244306 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1410649
- ↑ 10.0 10.1 Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin