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 & presacal lesions also occur
- sacral lesions may occur with aseptic meningitis
- gluteal & presacal 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
- vesicle is primary lesion of herpes simplex
- 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.
- ↑ 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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/16287791
- ↑ Corey L. Synergistic copathogens--HIV-1 and HSV-2. N Engl J Med. 2007 Feb 22;356(8):854-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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