Episode Details

Episode 121: Genital Herpes.     
Wendy and Grace discuss the signs, symptoms, diagnosis, and management of genital herpes. 

Written by Jaspreet Johal, MS4, Ross University School of Medicine. Edits by Grace Yi, MS2, University of California Los Angeles; and Wendy Collins, MS3, Ross University School of Medicine. Comments by Hector Arreaza, MD.  December 1, 2022.

You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.

Definition & Epidemiology

Genital herpes is a common sexually transmitted infection caused by a virus called herpes simplex virus (HSV for short). There are two types of HSV. HSV type 1 commonly causes orolabial herpes (known as cold sores), and HSV type 2 typically causes genital herpes, which can present as painful blisters or ulcers in the genital regions. 

In recent years, an increasing number of genital herpes cases have been associated with HSV-1, especially in women. 

HSV infections are widespread among the global population and spread person to person through oral-to-oral contact or vaginal, anal, and oral sexual contact. Transmission can occur during periods of subclinical viral shedding, as in even when individuals are asymptomatic. In 2020, the seroprevalence of HSV-2 in the United States was approximately 13 percent among patients aged 15 to 49, with more women affected than men. Fifty to 80 percent of American adults have oral herpes (HSV-1), which causes cold sores or fever blisters in or around the mouth. 

HSV is a lifelong infection characterized by periodic reactivations that can be triggered by fatigue, stress, or illness, among other factors. Antiviral therapy can shorten symptom duration in primary infection and can also treat and prevent recurrences. 

Types of Infection

Genital HSV infection can be classified into three types: primary, nonprimary, and recurrent. 

• Primary – Primary infection refers to an infection in a patient without preexisting antibodies to either HSV-1 or HSV-2.
• Nonprimary infection, a patient has a first occurrence of a genital HSV lesion but already has pre-existing HSV antibodies that are different from the HSV type related to the genital lesion.
• Recurrent – Recurrent infection refers to the reactivation of genital HSV (so the patient already has pre-existing antibodies in the serum)

Clinical Features 

The incubation period for developing genital herpes after exposure ranges anywhere from 2 to 12 days.

Most patients with primary HSV infection are asymptomatic or mildly symptomatic. However, in more severe cases, individuals can present with painful genital ulcers, dysuria, fever, tender local inguinal lymphadenopathy, and headache. HSV infection also presents with characteristic 2-4mm wide skin lesions that are vesicular or ulcerated. The vesicles are often clustered and can be fluid-filled with underlying erythema. Sometimes vesicles might have a depression in the center (called “umbilicated” vesicles.” 

It’s important to note, though, that the clinical presentation can vary based on the type of infection (primary, nonprimary, or recurrent). As a general rule of thumb, the initial presentation of a non-primary genital infection tends to be milder (as in, fewer systemic symptoms and lesions) than that of a primary infection. Recurrent infections also tend to be less severe than primary or