Today, genital herpes is one of the most common sexually transmitted diseases, with an estimated 775,000 new infections in the U.S. each year. Of these, 80% are fully unaware that they are infected.

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Man’s lip with herpes lesion

HSV Infection and Symptoms

HSV-1 is usually acquired during childhood and had been traditionally associated with oral herpes, while HSV-2 is sexually transmitted and primarily affects the anogenital region between the anus and genitals.

Symptom Patterns

After the initial infection, the viruses attach themselves to sensory nerve cells, where they remain for a lifetime. HSV can reactivate at any time, sometimes due to triggers. The frequency and severity of outbreaks tend to subside over time.

Diagnosis

Laboratory tests are sometimes used to make a definitive diagnosis, including newer generation HSV antibody tests which can identify HSV-1 or HSV-2 with greater than 98% specificity. These tests cannot detect new infections because it takes time for the body to make antibodies to the virus.

People who have a compromised immune system, such as HIV infection, have a higher frequency of HSV outbreaks that can be severe, spreading from the mouth or genitals to deeper tissues in the lungs or brain. As such, HSV has been classified as an “AIDS-defining condition” in people with HIV if it lasts longer than a month or if it affects the lungs, bronchi, or esophagus.

There is also increasing evidence that HIV transmission is substantially linked to HSV-2. Current research suggests that an active HSV-2 infection, whether symptomatic or asymptomatic, can increase the release of HIV from mucosal tissues in a process called “viral shedding.” As a result of such shedding, people with an undetectableHIV viral loadmay, in fact, have detectable viral activity in genital secretions.

While the use ofcombination antiretroviral therapy (cART)is known to decrease the incidence of symptomatic HSV, it doesn’t necessarily reduce HIV shedding. As a result, HIV-positive individuals with active HSV-2 infection are three to four times more likely to transmit HIV to a sexual partner.

Similarly, HIV-negative people with active HSV-2 infection are at increased risk of acquiring HIV.

There are several reasons for this:

These factors mean that HIV can effectively carry through the mucosal barrier of the vagina or anus directly into the bloodstream.

Treatment and Prevention of Herpes

There is currently no cure for either HSV-1 or HSV-2. Antiviral drugs may be used totreat HSV, often requiring higher doses for people with HIV, but is only recommended for those who experience outbreaks.

The oral pill form antivirals predominantly used to treat HSV are:

The drugs may be administered intermittently (upon initial infection or during flare-ups) or as ongoing, suppressive therapy for those with more frequent outbreaks. Most drug side effects are considered mild and include headaches, diarrhea, nausea, and body aches being among the most commonly noted.

Severe cases may be treated with intravenous acyclovir.

In order to reduce the risk of acquiring or transmitting HIV if you have HSV:

SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Celum, C.; Wald, A.; Lingappa, J.; et al.Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.New England Journal of Medicine.February 4, 2010; 362(5):427-39.Corey, L.; Wald, A.; Celum, C.; et al.The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.Journal of Acquired Immune Deficiency Syndromes.April 2004; 35(5):435-45.Corey, L.; Wald, A.; Patel, R.; al.Once-daily valacyclovir to reduce the risk of transmission of genital herpes.New England Journal of Medicine.January 2004; 350(1):11-20.Gray, R.; Wawer, M.; Brookmeyer, R.; et al.Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.Lancet.April 2001; 357(9263):1149-1153.Peña, K.; Adelson, M.; Mordechai, E.; et al.Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States,Journal of Clinical Microbiology.January 2010; 48(1):150-153.U.S. Centers for Disease Control and Prevention (CDC).Genital Herpes – CDC Fact Sheet. Atlanta, Georgia; accessed March 26, 2014.Wald, A.Genital HSV Infections.Sexually Transmitted Infections.June 2006; 82(3):189-190.

Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Celum, C.; Wald, A.; Lingappa, J.; et al.Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.New England Journal of Medicine.February 4, 2010; 362(5):427-39.Corey, L.; Wald, A.; Celum, C.; et al.The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.Journal of Acquired Immune Deficiency Syndromes.April 2004; 35(5):435-45.Corey, L.; Wald, A.; Patel, R.; al.Once-daily valacyclovir to reduce the risk of transmission of genital herpes.New England Journal of Medicine.January 2004; 350(1):11-20.Gray, R.; Wawer, M.; Brookmeyer, R.; et al.Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.Lancet.April 2001; 357(9263):1149-1153.Peña, K.; Adelson, M.; Mordechai, E.; et al.Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States,Journal of Clinical Microbiology.January 2010; 48(1):150-153.U.S. Centers for Disease Control and Prevention (CDC).Genital Herpes – CDC Fact Sheet. Atlanta, Georgia; accessed March 26, 2014.Wald, A.Genital HSV Infections.Sexually Transmitted Infections.June 2006; 82(3):189-190.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Celum, C.; Wald, A.; Lingappa, J.; et al.Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.New England Journal of Medicine.February 4, 2010; 362(5):427-39.Corey, L.; Wald, A.; Celum, C.; et al.The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.Journal of Acquired Immune Deficiency Syndromes.April 2004; 35(5):435-45.Corey, L.; Wald, A.; Patel, R.; al.Once-daily valacyclovir to reduce the risk of transmission of genital herpes.New England Journal of Medicine.January 2004; 350(1):11-20.Gray, R.; Wawer, M.; Brookmeyer, R.; et al.Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.Lancet.April 2001; 357(9263):1149-1153.Peña, K.; Adelson, M.; Mordechai, E.; et al.Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States,Journal of Clinical Microbiology.January 2010; 48(1):150-153.U.S. Centers for Disease Control and Prevention (CDC).Genital Herpes – CDC Fact Sheet. Atlanta, Georgia; accessed March 26, 2014.Wald, A.Genital HSV Infections.Sexually Transmitted Infections.June 2006; 82(3):189-190.

Celum, C.; Wald, A.; Lingappa, J.; et al.Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.New England Journal of Medicine.February 4, 2010; 362(5):427-39.

Corey, L.; Wald, A.; Celum, C.; et al.The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.Journal of Acquired Immune Deficiency Syndromes.April 2004; 35(5):435-45.

Corey, L.; Wald, A.; Patel, R.; al.Once-daily valacyclovir to reduce the risk of transmission of genital herpes.New England Journal of Medicine.January 2004; 350(1):11-20.

Gray, R.; Wawer, M.; Brookmeyer, R.; et al.Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda.Lancet.April 2001; 357(9263):1149-1153.

Peña, K.; Adelson, M.; Mordechai, E.; et al.Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States,Journal of Clinical Microbiology.January 2010; 48(1):150-153.

U.S. Centers for Disease Control and Prevention (CDC).Genital Herpes – CDC Fact Sheet. Atlanta, Georgia; accessed March 26, 2014.

Wald, A.Genital HSV Infections.Sexually Transmitted Infections.June 2006; 82(3):189-190.

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