Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus in HIV-infected patients
- Christine Johnston, MD, MPH
Christine Johnston, MD, MPH
- Assistant Professor of Medicine
- University of Washington
- Anna Wald, MD, MPH
Anna Wald, MD, MPH
- Professor of Medicine, Epidemiology, and Laboratory Medicine
- University of Washington
Herpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer disease (GUD) worldwide [1-5]. HIV-infected persons have a higher prevalence of HSV-2 infection, an increased risk of asymptomatic HSV genital shedding, and may have unusual clinical manifestations of HSV-2-related disease compared with HSV-2-seropositive patients who are HIV-uninfected.
This topic will review the epidemiology, clinical manifestations and diagnosis of HSV-2 infection in the HIV-infected host. The treatment of genital HSV in the HIV-infected host and the viral interactions between HIV and HSV-2 are discussed elsewhere. (See "Effect of herpes simplex virus on HIV infection: Implications for HIV prevention" and "Treatment of genital herpes simplex virus type 2 in HIV-infected patients" and "Treatment of drug-resistant genital herpes simplex virus infection in HIV-infected patients".)
The clinical designations of genital HSV infection are: primary, nonprimary first episode, and recurrent or reactivation disease (table 1). Among patients presenting with first episode of genital herpes, both virologic and serologic information is needed to accurately define the category of infection.
Primary — Primary infection refers to HSV infection in a patient without pre-existing antibodies to either HSV-1 or HSV-2.
Nonprimary — Nonprimary first episode infection refers to the acquisition of genital HSV-1 in a patient with preexisting antibodies to HSV-2 or the acquisition of genital HSV-2 in a patient with preexisting antibodies to HSV-1. Most HIV-infected adults with a first episode HSV infection have nonprimary infection because of prior exposure to HSV-1 [6,7].
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- Reactivation disease
- NATURAL HISTORY
- Clinical disease
- Viral shedding
- Effect of antiretroviral therapy on HSV-2-related disease
- CLINICAL MANIFESTATIONS
- Ulcerative disease
- Hypertrophic masses and pseudotumors
- Other unusual manifestations of HSV disease
- Ulcerative disease
- Hypertrophic lesions
- Patients with a recent history of genital disease
- DIFFERENTIAL DIAGNOSIS
- SCREENING FOR HSV-2 INFECTION
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS