Genital Herpes

Definition

Genital herpes is a sexually transmitted infection caused by herpes simplex virus (HSV), primarily HSV-2 and less commonly HSV-1, characterized by recurrent painful genital ulcers and systemic symptoms during initial infection.

Epidemiology

• HSV-2 is the leading cause of genital herpes globally; HSV-1 increasingly responsible in developed countries due to oral-genital transmission.
• Estimated global prevalence of HSV-2 in adults is 11–20%, higher in women than men.
• Transmission occurs via sexual contact with an infected individual, even when asymptomatic.
• Recurrent episodes are common, especially with HSV-2 infection.
• Immunocompromised patients may experience more severe or prolonged disease.

Etiology

• HSV-1 or HSV-2 infection transmitted through mucocutaneous contact.
• Primary infection occurs in susceptible individuals without prior HSV antibodies.
• Risk factors: multiple sexual partners, unprotected sex, immunosuppression, prior STI.
• Reactivation triggered by stress, illness, menstruation, or immunosuppression.

Pathophysiology

• Virus enters epithelial cells of genital mucosa and replicates.
• Virus spreads to sensory nerve endings and establishes latency in dorsal root ganglia.
• Reactivation leads to viral replication, migration along nerves, and recurrent lesions.
• Local immune response causes inflammation, vesicle formation, and ulceration.
• Asymptomatic viral shedding contributes to transmission.