Increasingly, first-episode genital herpes is caused by HSV-1 and is indistinguishable from HSV-2 infection, although recurrences and viral shedding occur less often with genital HSV-1 infection. Genital herpes is typically caused by HSV-2 and is the most common manifestation of HSV-2 infection. Lesions recur 1 to 12 times per year and can be triggered by sunlight or physiologic stress. The course of illness in untreated patients is 5 days to 10 days. Classic manifestations of oral HSV-1 include a sensory prodrome in the affected area, rapidly followed by lesions on lips and oral mucosa that evolve in stages from papule to vesicle, ulcer, and crust. Orolabial herpes (commonly known as cold sores or fever blisters) is the most common manifestation of HSV-1 infection. 3 HSV-2 infection increases the risk of HIV acquisition two- to three-fold, 4,5 and in coinfected patients, HSV-2 reactivation results in increases in HIV RNA levels in blood and genital secretions. 2 Approximately 70% of persons with HIV are HSV-2 seropositive, and 95% are seropositive for either HSV-1 or HSV-2. 1 While most cases of recurrent genital herpes are due to HSV-2, over the past decade, HSV-1 has become an increasing cause of first-episode genital herpes, causing up to 70% of infections in some populations, such as young adult women and men who have sex with men. Among persons aged 14 to 49 years in the United States, the HSV-1 seroprevalence is 47.8%, and the HSV-2 seroprevalence is 11.9%. Infections with human herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are common.
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