HSV-2 is a type of herpes simplex virus that typically causes genital herpes, a common sexually transmitted infection. Once acquired, HSV-2 establishes a lifelong presence in the body, residing in nerve cells and periodically reactivating. It is estimated that 520 million people aged 15–49 years worldwide have HSV-2 infection.
The primary way HSV-2 spreads is through skin-to-skin contact, usually during sexual activities such as vaginal, anal, or oral sex, with someone who has the virus. Transmission can occur even when no visible sores are present on the infected individual, known as asymptomatic shedding. Although HSV-1 is usually associated with oral herpes (cold sores), both HSV-1 and HSV-2 can cause genital herpes.
Recognizing Symptoms and Getting Diagnosed
Symptoms of a primary HSV-2 outbreak typically appear within 2 to 12 days after exposure. These can include painful blisters or small red bumps that progress into open sores, often accompanied by itching around the genitals, anus, or mouth. Some individuals may also experience flu-like symptoms such as headache, muscle aches, fever, and swollen lymph nodes in the groin area.
Recurrent outbreaks, which are common with HSV-2, are often milder and shorter in duration compared to the initial episode. These recurrences may be preceded by prodromal symptoms, such as tingling, itching, or shooting pain in the legs, hips, or buttocks, a few hours or days before new sores appear. Many people with HSV-2 have no symptoms or only very mild ones that go unnoticed, leading to unknowingly spreading the virus.
Diagnosis of HSV-2 can involve a swab test, where a sample is taken directly from a sore for viral culture or polymerase chain reaction (PCR) testing. PCR testing is highly accurate for active lesions. For individuals without active sores or those with atypical symptoms, a blood test can detect antibodies to HSV-2, indicating past exposure to the virus.
Treatment and Prevention
While there is no cure for HSV-2, antiviral medications can effectively manage symptoms and reduce the frequency of outbreaks. Commonly prescribed antiviral drugs include acyclovir, valacyclovir, and famciclovir, which work by inhibiting viral DNA synthesis to prevent the virus from replicating. These medications can be used as episodic treatment to shorten the duration and severity of individual outbreaks, or as suppressive therapy, taken daily to significantly reduce the number of recurrences and lower the risk of transmission to sexual partners. For instance, suppressive therapy with valacyclovir has been shown to reduce HSV-2 transmission to susceptible heterosexual partners by about 48%.
To reduce the spread of HSV-2, several strategies are recommended:
- Consistent and correct use of condoms during sexual activity, though condoms may not offer complete protection as they do not cover all affected areas.
- Abstaining from sexual activity during outbreaks or when prodromal symptoms are present, as the virus is most contagious during these times.
- Open communication and disclosure to partners about an HSV-2 diagnosis before sexual activity to help both individuals make informed decisions.
- Limiting the number of sexual partners to decrease the risk of exposure.
- Avoiding touching sores and then other body parts to prevent self-transmission or spread to other areas of the body.
Navigating Life with HSV-2
Living with an HSV-2 diagnosis can bring about emotional and psychological challenges, including feelings of stigma, anxiety, and concerns about disclosure to partners. It is common to experience initial feelings of embarrassment, shame, or even anger, but these emotions often lessen over time with adjustment and support. While the conversation about an HSV-2 diagnosis can be challenging, many individuals find that it does not hinder successful, enduring relationships.
In cases of pregnancy, the risk of transmission to the baby during vaginal delivery is low, particularly if the mother had HSV-2 prior to pregnancy, as her body will have developed protective antibodies. Healthcare providers may recommend antiviral medication in late pregnancy to further reduce the risk of active lesions and potential transmission to the newborn during birth.