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General Considerations For Genital Herpes.
Herpes simplex virus (HSV) infections are endemic in the United States and are a cause of recurrent genital and oral ulcerative disease. Genital herpes infection can be caused by type 2 virus (HSV-2), or less frequently by type 1 (HSV-1). Although most infections are asymptomatic, genital HSV infection, whether type 1 or 2, can cause vesicular and ulcerative disease in adults and severe systemic disease in neonates and immunocompromised individuals. Genital HSV infection increases the risk of HIV acquisition in infected persons.

HSV-2 transmission is almost always sexual, whereas HSV-1 is usually transmitted through nonsexual skin-to-skin contact. Current estimates place the incidence of HSV-2 infection at more than 1.5 million cases annually. In the general population, HSV-2 seroprevalence is low for persons younger than 12 years of age, rises sharply following onset of sexual activity, and peaks by the early 40s. HSV-2 seroprevalence in the United States rose 30% between 1978 and 1991 to 21.7%. The overwhelming majority of individuals with genital HSV infection have undiagnosed initial infections and unrecognized recurrences. Orolabial HSV-2 infection is rare and is almost always associated with genital infection.

HSV-1 infection frequently occurs as orolabial infection in childhood, and approximately 20% of children younger than 5 years of age are seropositive. The seroprevalence of HSV-1 rises almost linearly with increasing age to approximately 70%. In the general population over the past decade, HSV-1 has become an increasingly common cause of genital infection, with an estimated 50% of newly acquired genital herpes attributable to it in some populations.