It can therefore be assumed with a high level of certainty that when normal hygiene (including bodily hygiene) is maintained, modes of transmission other than sexual intercourse do not play a significant role. Due to its low environmental stability HSV can only remain infectious for a period of days on moist surfaces 22. This can most probably be ascribed to oral sex, which is more commonly practiced in this age group. In recent years an increased incidence of primary genital HSV-1 infection has been reported in the USA, particularly among adolescence and young adults 8, 9. This almost always occurs via direct contact during sexual intercourse. People with clinically manifest/apparent herpes genitalis and people who shed HSV asymptomatically can transmit the virus to their sexual partners. Affected patients and their sexual partners therefore more commonly suffer significant psychosocial problems. It must also be taken into account that recurrences themselves can cause high levels of emotional stress 20. In the experience of the reference laboratory for HSV and VSV of the Institute for Virology and Antiviral Therapy of the University Hospital of Jena, in its advisory capacity, frequent herpes genitalis recurrences particularly affect young women with a high burden of stress in the family and workplace.
Compared to primary infection, symptoms of recurrence are much less severe and the clinical course shorter 19.
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Recurrences almost always initially present with prodromal symptoms such as neuralgic symptoms, dysaesthesia or lumbosacral dermatome pain 1–2 days before skin and mucosal lesions erupt 18. Recurrent genital HSV-1 infections occur over five times less commonly 17. Recurrences occur in almost every person suffering symptomatic primary herpes genitalis due to HSV-2, in a third of patients frequently (at least 6 times a year) 16.
Endogenous viral reactivations may manifest as recurrent herpes genitalis. Numerous physiological and environmental factors such as fever, UV light, menstruation, stress or trauma can function as triggers 14, 15. Viral reactivation is common in the presence of immunogenetic predisposition, though reactivations decrease with increasing age. From here the virus can reactivate, causing recurrent infection. Genital HSV-2 infection is associated with an increased risk of HIV infection 10.įollowing the primary eruption the virus establishes lifelong latency in sensory neural ganglions 13 in the case of primary genital infection the sacral ganglions are mainly involved. There is published evidence of this in the USA 8, 9 but not yet in Germany. A reduced HSV-1 seroprevalence among young people (adolescents) and adults may be associated with higher numbers of primary HSV-2 or HSV-1 infections due to oral sex. Partial clinical cross-immunity exists between HSV-1 and HSV-2 and as a result, primary genital HSV-2 infection may be asymptomatic in patients with HSV-1 immunity and vice versa. As a possible reason for this it has been suggested that men have asymptomatic genital HSV-2 infections more often than women, resulting in higher virus transmission rates from men to women 7. Numerous studies have shown a significantly higher HSV-2 seroprevalence in women than in men 4, 5.
Higher seroprevalences are found internationally among people who regularly change sexual partners and among homosexual men 6. 3 % in 10–15-year-olds to 7 % in the age group 16–18 years, to approx. In Germany the prevalence of anti-HSV-2 IgG antibodies rises from approx. Since HSV-2 is mainly transmitted through sexual intercourse infection rates only rise after puberty. From the age of 40 years and onwards one can assume an HSV-1 seroprevalence of ≥ 85–90 % 5. 70 % in 16–18 year olds and around 80 % in adults aged 28–30 years 4. Current data on seroprevalence in Germany show a rise in anti-HSV-1 IgG to approx. Initial infection with HSV-1 occurs most often during childhood following the disappearance of maternal antibodies during the first year of life. The primary mode of transmission of both HSV-1 and HSV-2 is through direct contact. Type-specific epitopes include the viral glycoproteins (g) gG (HSV-1 and HSV-2) and gC (HSV-1) 2, 3. Due to marked genetic homology between HSV-1 and HSV-2 numerous biological similarities and antigenic cross-reactions between the viruses exist. Both organisms are enveloped DNA viruses that are sensitive to disinfectants and environmental factors 1. It is caused by the herpes simplex virus type 2 (HSV-2) and also, increasingly, the herpes simplex virus type 1 (HSV-1). Herpes genitalis is among the most common sexually transmitted infections.