Genital herpes guide: Etiology and epidemiology
Etiology and epidemiology of the genital herpes.
Note: This guide provides minimal information about neonatal herpes. For more information, refer to the Canadian Paediatric Society Position Statement about the prevention and management of neonatal herpes simplex virus infections.
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Etiology
Herpes simplex virus (HSV) types 1 and 2 cause genital herpesFootnote 1.
Epidemiology
In Canada, the annual incidence of genital herpes due to HSV-1 and HSV-2 is not knownFootnote 2. Many infections are undiagnosed and therefore, epidemiological reports can only provide a partial picture of HSV incidence and prevalenceFootnote 3. Several studies have tested for type-specific immunoglobulin G (IgG) antibodies. Type-specific serology (TSS) distinguishes between antibodies to HSV types 1 and 2, however a positive (reactive) serological result does not confirm the site of infection, which limits its usefulness for estimating the prevalence of genital herpes.
The 2009 to 2011 Canadian Health Measures Survey (CHMS) estimated HSV-2 seroprevalence among Canadians aged 14 to 59 at 13.6%Footnote 4. Although HSV-2 has been the most common cause of genital herpes historicallyFootnote 5, there has been a significant rise in genital HSV-1 infections, especially in femalesFootnote 6Footnote 7.
HSV-2 antibody testing of leftover serum submitted for antenatal testing in British Columbia revealed an overall seroprevalence of 17.3%, with an increase in prevalence with age, ranging from 7.1% in females 15-19 years to 28.2% in those 40-44 yearsFootnote 8.
In studies conducted in Nova ScotiaFootnote 9 and New BrunswickFootnote 10, cultures performed on samples taken from lesions of genital herpes indicated that more than 50% of infections were due to HSV-1Footnote 9Footnote 10. In both studies, younger people had a higher percentage of genital herpes due to HSV-1Footnote 9Footnote 10.
In Canada, from 2000 to 2003, the incidence of neonatal HSV was 5.9 per 100,000 live births; 62.5% of cases were attributable to HSV-1Footnote 11.
References
- Footnote 1
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Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983;98(6):958-972.
- Footnote 2
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Li X, Kim PHK, Gilbert M. Trends in Herpes Simplex Virus Cases in British Columbia, 1992-2006. –June 19, 2008. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.516.5960&rep=rep1&type=pdf
- Footnote 3
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Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015 Aug 28;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137.
- Footnote 4
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Rotermann M, Langlois KA, Severini A, Totten S. Prevalence of Chlamydia trachomatis and herpes simplex virus type 2: Results from the 2009 to 2011 Canadian Health Measures Survey. Health Rep. 2013;24(4):10-15.
- Footnote 5
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The American College of Obstetricians and Gynecologists. Frequently asked questions. Gynecologic problems. FAQ054, Genital Herpes. 2019 https://www.acog.org/womens-health/faqs/genital-herpes
- Footnote 6
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Gupta R, Warren T, Wald A. Genital herpes. Lancet. 2007;370(9605):2127-2137.
- Footnote 7
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Nilsen A, Myrmel H. Changing trends in genital herpes simplex virus infection in Bergen, Norway. Acta Obstet Gynecol Scand. 2000;79(8):693-696.
- Footnote 8
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Patrick DM, Dawar M, Cook DA, Krajden M, Ng HC, Rekart ML. Antenatal seroprevalence of herpes simplex virus type 2 (HSV-2) in Canadian women: HSV-2 prevalence increases throughout the reproductive years. Sex Transm Dis. 2001;28(7):424-428.
- Footnote 9
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Forward KR, Lee SH. Predominance of herpes simplex virus type 1 from patients with genital herpes in Nova Scotia. Can J Infect Dis. 2003;14(2):94-96.
- Footnote 10
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Garceau R, Leblanc D, Thibault L, Girouard G, Mallet M. Herpes simplex virus type 1 is the leading cause of genital herpes in New Brunswick. Can J Infect Dis Med Microbiol. 2012;23(1):15-18.
- Footnote 11
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Kropp RY, Wong T, Cormier L, et al. Neonatal herpes simplex virus infections in Canada: results of a 3-year national prospective study. Pediatrics. 2006;117(6):1955-1962.
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