Typical herpetic genital lesions and/or symptoms such as prodrome (for example burning, itching, or tingling at site where lesions occur), paraesthesia, vesicles, followed by single/multiple and painful shallow ulcers, and healing with crusting scabs.
Atypical lesions are common and a high clinical suspicion should be maintained followed by appropriate testing.
Both HSV type 1 and type 2 can infect the genitals and testing should be type specific.
Nucleic Acid Amplification Test
Note: NAAT refers to Nucleic Acid Amplification Test, such as PCR
swab specimen from an infected site
type specific PCR.
HSV serology for IgM and IgG is routinely available
IgM is unreliable
the sensitivity and specificity of IgG may be between 95 to 97% depending on the specific assay
screening with serology is not routinely recommended
use of this test may be indicated in certain clinical settings such as
Patient education is often complex and patients should be referred to a health advisor for counselling at first or follow up visits.
HSV is common with an approximate prevalence of 80 to 90% for type 1, and 12 to 80% (depending upon the population tested) for type 2. Recent seroprevalence data found 1 in 8 Australian adults are infected with HSV 2.
Type 1 HSV in the genitals is more common than type 2 HSV in the younger population and will recur much less frequently than type 2 HSV in the genitals.
Up to 80% of people infected with HSV type 2 are not aware that they are infected as they are asymptomatic or have not had their symptoms of HSV diagnosed. In serodiscordant relationships, the risk of acquiring HSV 2 from an infected male to a non infected female is about 10% and infected female to non infected male about 5% per annum.
The following points should be covered:
HSV type 1 and 2 infections are common in the community
the natural history of HSV infection including greater severity of initial attack, decreasing frequency and severity of recurrences with time
treatment options including suppressive therapy
methods of transmission and treatment options to reduce risk of transmission
nature of asymptomatic viral shedding during which time transmission may occur
identification of prodromal symptoms which may assist in early recognition and treatment of recurrences
avoidance of sex during outbreaks and optional use of condoms at other times which may decrease transmission
a pregnant women should inform her treating doctor if she or her partner has HSV infection
infection with HSV type 2 in the genitals can increase the risk of HIV acquisition or transmission.
These guidelines are based on review of current literature, current recommendations of the United States Centers for Disease Control and Prevention, World Health Organization, the British Association for Sexual Health and HIV and local expert opinion.
They are written primarily for use by Adelaide Sexual
Health Centre staff and some flexibility is required in applying them to certain private practice situations.
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