Genital herpes guide: Key information and resources
This guide is about the management of genital herpes. The Genital Herpes Counselling Tool complements this guide.
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.
On this page:
- Public health importance
- Screening
- Diagnostic testing
- Treatment
- Follow up
- Partner notification
- Resources
Public health importance
Herpes is a chronic infection characterized by clinical and subclinical recurrences. Asymptomatic shedding is frequent. Transmission can occur from both asymptomatic and symptomatic people.
Historically, herpes simplex virus (HSV) type 2 has been the most common cause of genital herpes; however, genital herpes can also result from infection with HSV type 1. Globally, there has been an increase in total HSV-1 infections and a significant increase in genital HSV-1 infections.
HSV can cause severe systemic disease in neonates and immunocompromised people.
Untreated primary genital HSV-1 or HSV-2 infection in the second half of pregnancy carries a 30%–50% risk of vertical transmission. Neonatal herpes can cause serious morbidity (including long-term neurological and developmental sequelae) and is associated with high mortality.
Genital herpes, particularly when acquired recently, increases the risk of human immunodeficiency virus (HIV) acquisition and transmission.
Note: Genital and neonatal herpes infections are reportable in some provinces and territories. Refer to your provincial or territorial reporting guidelines.
Screening
Screening for HSV is not recommended in people who do not have a history of anogenital lesions.
Diagnostic testing
In symptomatic people, herpes is commonly diagnosed with viral identification techniques such as the Nucleic Acid Amplification Test (NAAT) or viral culture. If testing is not possible or testing of a symptomatic person yields negative results, HSV type-specific serology (TSS) may be useful for diagnosis. TSS testing can identify the need for preventive measures by demonstrating whether partners are serodifferent (both partners have HSV, but different types), serodiscordant (only one partner has HSV) or concordant (both partners have the same HSV type). The availability of TSS varies across Canada.
Treatment
Treatment options include oral acyclovir, famciclovir and valacyclovir. If used during a first episode of genital herpes, these medications should be started within three to seven days of symptom onset for maximum benefit. The duration of treatment varies from five to ten days depending on the medication and the clinical stage at presentation.
A first episode of genital herpes in pregnancy should be treated with antivirals. Caesarean delivery is strongly recommended if a first episode of genital herpes occurs in the third trimester. When there is a history of genital herpes, suppressive therapy from the 36th week of gestation may help prevent recurrences and asymptomatic shedding and thus may reduce the need for Caesarean section.
Daily suppressive therapy can help control signs and symptoms, improve quality of life and reduce HSV transmission. Suppressive therapy is recommended for those with frequent (>6/year) or highly symptomatic recurrences. It may also be considered for people seeking to reduce risk of vertical transmission or transmission to a sexual partner.
Follow up
Follow up is indicated for those experiencing a recurrence, pregnant persons, infants at risk and when drug resistance is suspected.
Partner notification
Partner notification is not required as a public health measure for genital herpes, in part because most clinically evident first episodes are recurrences and also because it is difficult to assess whether a sexual partner already has HSV. People experiencing a first episode of genital herpes and those with recurrent disease should be encouraged to inform their partners so that the partners are aware of the risk of infection and can consult their healthcare provider as needed for diagnosis and treatment.
Resources
Awareness resources
Journal articles
Other guidance
- Canadian Paediatric Society Position Statement: Prevention and management of neonatal herpes simplex virus infections
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