HSV-2 infection, which causes genital herpes, is widespread all over the world and is transmitted almost exclusively through sexual contact. HSV-2 is the main cause of genital herpes, although it can also cause the herpes simplex virus type 1 (HSV-1). Infection of HSV-2 remains for life and is not curable.
Scale of the problem
Genital herpes caused by HSV-2 is a global problem: it is estimated that in 2016. 491 million people (13%) aged 15-49 years worldwide had this infection.
More women than men are infected with HSV-2; it is estimated that in 2016. 313 million women and 178 million men lived with the infection. This is due to the fact that sexually transmitted HSV is more effectively transmitted from a man to a woman than from a woman to a man.
It is estimated that the highest prevalence rates of infection caused by HSV-2 are in Africa (44% for women and 25% for men), followed by America (24% for women and 12% for men). Prevalence increases with age, although adolescents are the most newly infected.
Signs and symptoms
Genital herpetic infection is often asymptomatic or with mild symptoms that remain unrecognized. Most infected people do not know that they are infected. Generally, about 10-20% of people infected with HSV-2 report an earlier diagnosis of genital herpes. However, clinical studies closely monitoring cases of primary infection have shown that up to one-third of newly infected people may have symptoms.
When symptoms do occur, genital herpes is characterized by one or more vesicles or open lesions, called ulcers, in the genital or anal region. In addition to genital ulcers, symptoms of primary infection with genital herpes are often fever, body scrapes and inflammation of the lymph nodes.
After the initial episode of herpes infection in the genital area caused by HSV-2, symptoms often recur, but are less intense than when they first appeared. The frequency of symptoms tends to decrease over time, but they may appear over many years. Before ulcers appear in the genital area, people infected with HSV-2 may feel a slight tingling or firing pain in the legs, thighs and buttocks.
Transmission of infection
HSV-2 is transmitted mainly during sexual intercourse, by contact with genital surfaces, skin, affected areas or fluids of a person infected with the virus. HSV-2 can be transmitted through the skin in the genital area or anal area that looks normal and is often transmitted even when there are no symptoms. In rare cases, an infection caused by GBP-2 may be transmitted from mother to child at birth and cause neonatal herpes.
HSV-2 and HIV
It has been proven that HSV and HIV affect each other. Infection caused by HSV-2 increases the risk of HIV infection by about three times. In addition, people infected with HIV and HSV-2 are more likely to transmit HIV to others. HSV-2 is one of the most common infections among people living with HIV, and is found in 60-90% of people with HIV.
HSV-2 infection in people living with HIV (and other immunocompromised individuals) is often more severe and more frequent. In later stages of HIV infection, HSV-2 can lead to more severe, albeit rare, complications such as meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or a dysfunctional infection.
Neonatal herpes development can occur when a newborn baby comes into contact with HSV (HSV-2 or HSV-1) in the genital tract during childbirth. Neonatal herpes is rarely developed, estimated at 10 out of 100 000 births worldwide, but this severe condition can lead to persistent neurological disability or death. Women who have experienced genital herpes before pregnancy have a very low risk of transmitting HSV to their children. The highest risk of neonatal herpes occurs when a woman first becomes infected with HSV in late pregnancy, partly because the highest levels of HSV concentration in the genital tract are observed in the early stages of infection.
Recurrent symptoms of genital herpes can be painful, and the infection can lead to social stigmatization and psychological stress. These factors can have significant adverse effects on quality of life and sexual relationships. However, over time, most people with herpes will adapt to live with this infection.