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There are no specific recommendations for, or against herpes typing and the clinical community is divided as to the appropriateness of this activity.
Historically, HSV-1 has been associated with oral infections while HSV-2 has been associated genital infections. This distinction is no longer valid and today as 30-50% of genital herpes infections are caused by HSV-1 (1) and 5-20% of oral infections are caused by HSV-2. The treatments for HSV infections, whether for acute infection or suppressive therapy, are the same for HSV-1 and HSV-2 (1). These observations suggest that HSV typing is a waste of time.
However, the frequency of HSV reactivation depends upon the virus type and the anatomic site of infection (2). Genital HSV-2 infections recur 8-10 times more frequently than HSV-1 genital infections (1 - 3). In addition, more than 80% of patients with primary HSV-2 genital infections have a recurrence within 12 months compared with 55% of patients with HSV-1 genital infections (2). Oral HSV-1 infections recur much more frequently than HSV-2 infections of the oropharynx (1 - 3). Thus, HSV typing has a role when counseling patients and discussing disease prognosis.
The Sexually Transmitted Treatment Guidelines (1) published by the Centers for Disease Control and Prevention also include recommendations for preventing neonatal infections. These recommendations include counseling pregnant women who are not infected with HSV-2 to avoid intercourse during the third trimester with men who have genital herpes. Similarly, pregnant women who are not infected with HSV-1 should be counseled to avoid genital exposure to HSV-1 during the third trimester (e.g., cunnilingus with a partner with oral herpes and vaginal intercourse with a partner with genital HSV-1 infection).
Finally, the psychological impact of genital HSV can be substantial and many patients feel stigmatized if they have an HSV-2 infection. As a result, a significant proportion of HSV-infected patients want to know which herpes serotype is causing their disease. Physicians often honor these requests because HSV serotyping data has an impact on patient counseling and prognosis.
Literature Cited
1. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(No. RR-6):1-82.
2. Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L. Recurrences after oral and genital herpes simplex virus infection: Influence of anatomic site and viral type. N Eng J Med 1987;316:1444-1449.
3. Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infection: Clinical manifestations, course and complications. Ann Intern Med 1983;98:958-972.
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