Herpes, Type II

Incidence within USA of HSV-2 is estimated at 40–60 million (20% of sexually active adults).

Approximately 536 million people (16% of population) infected worldwide, most unaware of the disease.

Highest prevalence in women, African Americans, and lower socioeconomic groups.

Frequency and severity of infection increases in immunocompromised pts, including HSV encephalitis.

Incidence of neonatal HSV infection is estimated at 1:2000-5000 deliveries.

Vertical transmission from infected mother to fetus during vaginal birth

Intrauterine fetal infection after rupture of membranes

Transmission of infection to health care personnel resulting in herpetic whitlow via inoculation of virus into digits is very well described and completely preventable with universal precautions (e.g., gloves at all times).

Neonatal herpetic infection during vaginal births.

Viremia secondary to needle placement within infected area during regional anesthesia with possible extension of infection to adjacent areas.

Secondary bacterial or fungal infection of herpetic lesions.

Primarily caused by infections below the waist transmitted by sexual contact.

Maternal primary HSV-2 infection is associated with spontaneous abortion.

Newborns can be infected with HSV-2 during vaginal delivery from the mother’s genital infection (high neonatal mortality).

Primary genital HSV-2 infection has the highest incidence of systemic symptoms (malaise, fever, headache, myalgias).

Latent infection remains dormant in sensory ganglia, innervating the infected area until reactivation.

Recurrent infection involves clusters of genital sores (papules and vesicles) on outer surface of genitals, usually appearing 4–7 d post HSV exposure.

No increased risk of reactivation of HSV-2 is associated with neuraxial anesthesia.

Chronic recurrent HSV-2 infection is associated with development of cervical and vulvar cancer.

Reactivation is known to occur with exposure to UV light, immunosuppression, trauma, and fever.

Dx by viral culture (gold standard) is the most sensitive and specific (rapid Dx by Tzanck smear).

Genital herpes increases the risk of transmission and acquisition of HIV-1 infection threefold to fourfold.