Genital herpes

Genital herpes (GH) is the fourth most common sexually transmitted infection diagnosed at genitourinary medicine (GUM) clinics in the United Kingdom.1 There are two herpes simplex virus (HSV) types; HSV-2 is almost entirely associated with genital disease whereas HSV-1 is associated with both oropharyngeal and genital disease. In some,2–7 although not all,8 areas of the United Kingdom HSV-1 accounts for more than 50% of first episodes of GH. Differentiating between HSV types yields important prognostic information. Genital infection with HSV-1 shows a milder natural history than infection with HSV-2 and both symptomatic recurrences and subclinical shedding are less frequent.9–16

GH is classified as primary when an HSV seronegative person acquires HSV-1 or HSV-2; initial non-primary when a person with antibody against one virus type acquires the opposite type; and recurrent. Primary and initial infections are often asymptomatic or unrecognised, but can become symptomatic at any time.9,12,14 Thus a first episode of GH may represent a recently acquired or a long lasting infection. Most asymptomatic individuals with HSV-2 subsequently develop symptomatic disease.14

GH is a lifelong infection that can cause substantial morbidity to those infected and have serious consequences, including neonatal herpes and increased risk for HIV acquisition and transmission.17 As clinical signs and symptoms are often subtle, most infections are unrecognised and undiagnosed.18,19 Infected people shed the virus intermittently, regardless of whether lesions are clinically apparent.15

RECOMMENDED TESTS

Screening of asymptomatic GUM clinic attendees by either HSV antibody testing (evidence level IV, recommendation grade C)20–24 or HSV detection in genital specimens (evidence level IIa, recommendation grade B)18,20 is not recommended at present, although this area is under active review.

HSV antibody testing

Testing for HSV type specific antibodies can be used to diagnose HSV infection in asymptomatic …