What is Herpes Simplex Type 2?
Genital herpes can be caused by either type 1 or type 2 of the herpes simplex virus, and it could show up as an initial or recurring infection. In most cases, the virus multiplies in the skin cells and stays dormant in sensory nerves, causing recurrent localized skin sores. It’s one of the most common sexually transmitted infections (STIs), but it’s often overlooked due to its subtle symptoms. This article discusses important points about lab tests, antiviral treatments, and preventive measures for genital herpes. It’s designed to help healthcare professionals take care of patients with this condition and provide better advice on lab testing, treatment, and prevention.
The herpes simplex virus type 2 (HSV-2) remains a common infection, affecting about 22% of adults aged 12 and over, which equals 45 million adults in the U.S. alone. While HSV-1 often affects the area around the mouth and can sometimes cause genital sores, HSV-2 is typically the cause when patients report genital sores. However, most outbreaks present nonspecific symptoms like genital itching, discomfort, and skin scratches, which may lead to delayed diagnosis and treatment. This could result in additional exposure to people who haven’t been infected
What Causes Herpes Simplex Type 2?
Getting infected with HSV-2, also known as genital herpes, typically happens when a person comes into direct contact with fluids, like saliva, that contains the virus. This usually occurs during sexual activity. That’s why the risk for HSV-2 increases after puberty when sexual activity often begins.
HSV-2 doesn’t survive long outside the body—it can only stay infectious on moist surfaces for a few days. So, it’s not often spread in ways other than sexual activity.
Pregnant women should be aware that both first-time and repeat HSV infections can be passed to their baby, leading to a condition called congenital HSV infection.
Risk Factors and Frequency for Herpes Simplex Type 2
Genital herpes is a common sexually transmitted infection (STI). Most cases are caused by herpes simplex virus type 2 (HSV-2), but some cases are caused by herpes simplex virus type 1 (HSV-1). The virus mainly spreads through direct contact with herpes sores.
- About 16% of people aged 14 to 49 were found to have HSV-2 between 2005 and 2010.
- People often have antibodies to HSV-2 by the time they reach puberty, and this is often linked to their level of sexual activity.
- More women are infected than men.
- The likelihood of infection increases with the number of sexual partners.
- Non-Hispanic African Americans have higher rates of infection than non-Hispanic Whites.
- About 85% to 90% of infections go unnoticed and are not diagnosed.
In the U.S., herpes is one of the main causes of genital ulcers. Globally, over 23 million new cases are reported each year.
Signs and Symptoms of Herpes Simplex Type 2
It’s not uncommon for individuals to visit their local doctor’s office due to issues related to the genital area, even though a definite diagnosis may not always be possible. One such concern could be HSV-2, a virus that often causes painful sores, ulcers, crusty patches, tender swellings in the lymph nodes, and a painful or burning sensation when urinating.
These symptoms often start as flat or small, raised spots on the skin or mucous membranes. The spots can then develop into vesicles or pus-filled bumps that can persist for up to three weeks. Especially in women, these genital lesions can cause severe pain, swelling of the vulva (outer female genitalia), and painful urination.
It’s important to highlight that HSV-2 usually doesn’t cause painless ulcers. Some people with HSV-2 can also experience full-body symptoms like fever, headaches, and a general feeling of being unwell. These symptoms often occur due to the virus spreading in the bloodstream, a condition recorded in about 24% of patients in one study.
Testing for Herpes Simplex Type 2
If you have symptoms of a herpes simplex virus (HSV) infection, doctors may want to test a sample taken directly from any sores or blisters you have. Ideally, this should be done within 72 hours of the sores appearing, and it’s best to avoid testing any sores that look like they’re starting to heal or crust over. The area shouldn’t be cleaned with any alcoholic solutions before the sample is taken.
Swabs for testing can be collected from the skin by gently opening up any blisters with a sterile needle, or from the urethra, cervix, eye, or rectum using special tools. Other options, if a direct swab can’t be taken, include PCR testing, which checks for the genetic material of the virus, or a Tzank smear, which although not very sensitive, can reveal the presence of HSV.
Other types of testing include direct fluorescent antigen test, HSV serotyping to identify the type of herpes virus, and antibody tests.
Since HSV symptoms can sometimes be mistaken for a urinary tract infection, your doctor might also check your urine. Given that HSV is often transmitted sexually, you might also be tested for other sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and HIV.
Treatment Options for Herpes Simplex Type 2
The management of genital herpes involves both medication and lifestyle changes. The aim is to prevent the spread of the virus and control outbreaks, through antiviral treatment and counseling about the risk of sexual transmission.
For first-time outbreaks, also known as primary infection, ulcerating sores usually resolve on their own in around 19 days. The treatment is the same for those who have had the virus before, known as secondary or non-primary infection.
Antiviral medication is central to treating genital herpes, with the most common drug being acyclovir. This medication fights all types of herpes viruses and has been approved by the FDA for both treating and suppressing herpes and Varicella-zoster virus, which causes chickenpox and shingles. Other treatments include penciclovir (more often used for cold sores), and ganciclovir (which is also effective against the cytomegalovirus). These medications are targeted towards cells which are already infected with the virus and are designed to stop the virus from reproducing.
Acyclovir comes in various forms: ointment, pills, and IV injection. Its oral form is less effective, therefore a derivative of acyclovir called valacyclovir with better absorption rate was created. Side effects of acyclovir can include kidney issues and a decrease in white blood cells at high doses. Resistance to acyclovir, where the drug’s effectiveness is reduced, has been reported in patients with weakened immune systems and those on long-term therapy with acyclovir for genital herpes.
There’s ongoing research to improve herpes treatment, including potential new drugs and alternative treatments, such as essential oils. Some of these oils, including peppermint, Australian tea tree, and eucalyptus oil, have shown antiviral properties against the herpes virus in lab studies. However, the use and effectiveness of these oils largely depend on application before the virus enters host cells, therefore, they might be more beneficial for ongoing treatment than for treating existing outbreaks.
Currently, there’s no available vaccine for herpes. However, scientists are looking to develop vaccines not only to speed up the healing of visible sores and reduce the severity of symptoms but also to minimize the shedding of the virus from the skin, which could lessen the intensity of future outbreaks.
What else can Herpes Simplex Type 2 be?
There are several medical conditions that can cause genital ulcers, which are sores in the genital area. These conditions can be classified into two categories: infectious and non-infectious.
For infectious conditions, which are caused by some types of bacteria, viruses, or fungi, examples include:
- Syphilis
- Chancroid
- Lymphogranuloma venereum
- Granuloma inguinale
On the other hand, non-infectious conditions can also lead to genital ulcers. These are not caused by infections but by other health factors or diseases. Examples of these include:
- Crohn’s disease
- Behcet syndrome
- Reactions to some medications (fixed drug eruptions)
- Psoriasis
- Sexual trauma
It’s also important to know that people who have genital HSV-2 infection, which is a type of herpes virus, have a higher risk of getting HIV. Because of this, testing for HIV may be required and can change how HSV-2 is treated.
What to expect with Herpes Simplex Type 2
It should be noted that HSV-2, also known as genital herpes, cannot be cured. However, if symptoms are identified early and medication is used promptly, this can help to suppress the spread of the virus more quickly. To reduce the risk of passing the virus to a partner who doesn’t have it, avoiding sexual activity during times when the virus is active is recommended. The herpes virus family can have significant impacts on the nervous system, and regrettably, once an individual contracts HSV-2, they carry the virus for life.
Possible Complications When Diagnosed with Herpes Simplex Type 2
Genital HSV-2 infection can up your chances of getting HIV, so having an HIV test might affect how HSV-2 is treated.
Without treatment, HSV-2 can cause an infection of the brain and spinal cord called meningitis, though any part of the nervous system could be affected by HSV-2.
Around 36% of women and 13% of men suffer from a specific type of meningitis where no bacterial growth is observed and this often leads to their hospitalization. This type of meningitis is often seen during the early phases of genital herpes and during herpes outbreaks. During these periods, patients may experience a number of generalized symptoms like headaches, neck stiffness, and mild fever. If you have these symptoms, you should get a lumbar puncture immediately. This is a procedure where a needle is inserted into the lower spine to collect fluid for testing. The lab results often show an increase in a type of white blood cell called lymphocytes. The lab typically tests the fluid for virus using a technique called PCR, which is the recommended way to diagnose this condition.
HSV-2 can also cause acute retinal necrosis. Symptoms include red eyes (can be one or both), pain around the orbit of the eye, and decreased vision. The examination often shows inflammation of the eye or nearby tissues and destruction of retinal tissues leading to detachment of the retina from the underlying layer. This condition can occur alongside HSV-2-induced meningitis.
Preventing Herpes Simplex Type 2
- It is advised to use condoms.
- It’s best to avoid sexual activity when there are visible signs of active viral presence, such as sores.
- If you are planning on being sexually active frequently, you might want to think about preventative treatment ahead of time.
