Herpes simplex virus
### Key Facts
- **Prevalence**: An estimated 3.7 billion people under age 50 (67% of the global population) have herpes simplex virus type 1 (HSV-1) infection, the primary cause of oral herpes. Approximately 491 million people aged 15–49 (13% worldwide) have herpes simplex virus type 2 (HSV-2) infection, the main cause of genital herpes.
- **Asymptomatic Cases**: Most HSV infections are asymptomatic or go unrecognized, but symptoms can include painful blisters or ulcers that may recur over time.
- **HIV Risk**: HSV-2 infection significantly increases the risk of acquiring and transmitting HIV.
### Overview
- **Types of HSV**: There are two main types of herpes simplex virus:
- **HSV-1**: Mainly spreads through oral contact and causes infections in or around the mouth (oral herpes or cold sores). It can also cause genital herpes.
- **HSV-2**: Spreads primarily through sexual contact and causes genital herpes.
- **Symptoms**: Many people with HSV have no symptoms or only mild symptoms. When symptoms do occur, they often include painful, recurring blisters or ulcers. The first outbreak may also involve fever, body aches, and swollen lymph nodes. Subsequent outbreaks tend to be less severe.
### Symptoms
- **Oral Herpes (HSV-1)**: Common symptoms include blisters or open sores in or around the mouth or lips.
- **Genital Herpes (HSV-2)**: Symptoms include bumps, blisters, or open sores around the genitals or anus. These sores are typically painful and may ooze and crust over.
### Treatment
- **Medications**: Antiviral medications like acyclovir, famciclovir, and valacyclovir are commonly used to manage HSV. They reduce the duration and severity of symptoms but do not cure the infection.
- **Pain Management**: Over-the-counter pain relievers (e.g., paracetamol, naproxen, ibuprofen) and topical numbing agents (e.g., benzocaine, lidocaine) can help alleviate pain from sores.
- **Recurrence Management**: Treatment is most effective when started within 48 hours of symptom onset. Taking a lower daily dose of antiviral medication can reduce the frequency of outbreaks.
### Transmission
- **HSV-1**: Primarily transmitted through contact with sores, saliva, or oral surfaces. It can also be transmitted to the genital area through oral-genital contact.
- **HSV-2**: Mainly transmitted through sexual contact, even when no symptoms are present.
### Complications
- **HSV-2 and HIV**: HSV-2 increases the risk of acquiring HIV and is a common co-infection among people living with HIV.
- **Severe Disease**: In immunocompromised individuals, herpes can cause severe symptoms, frequent recurrences, and rare complications like encephalitis or keratitis.
- **Neonatal Herpes**: Occurs when HSV is transmitted from mother to child during delivery, potentially leading to serious outcomes such as neurologic disability or death.
### Prevention
- **Avoiding Transmission**: People with symptoms should avoid oral contact, sexual activity, and sharing objects that have touched saliva. Using condoms consistently can reduce the risk of genital herpes and other STIs, though transmission can still occur in areas not covered by the condom.
- **Pregnancy Precautions**: Pregnant women with HSV symptoms should inform their healthcare provider to prevent neonatal herpes, particularly in late pregnancy.
### WHO Response
- **Awareness and Access**: WHO is working to increase awareness of HSV infections, improve access to antiviral treatments, and promote HIV prevention efforts for those with genital herpes.
- **Research**: WHO and partners are supporting research to develop new prevention and control strategies, including vaccines and topical microbicides.
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