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Genital herpes is a condition caused by infection with the Herpes simplex virus (HSV). The infection is sexually transmitted and has the potential to cause a recurrent, painful, blistering rash in the genital area and significant physical and psychological distress in sufferers for many years. Alternatively, it may provoke a single, trivial rash which may go entirely unnoticed, or have no external effect at all, but generally taking up life-long residence in the sacral ganglia, bundles of nerve cells within the pelvis. The infection may be caused by HSV type 1 or type 2 but globally the majority of cases are caused by type 1. 1 Neonatal infection has a high mortality and, in addition, genital herpes is associated with an increased risk of HIV acquisition by two to threefold, with HIV transmission on a per-sexual act basis increased by up to fivefold. 2 3 The lowest prevalence is in western Europe affecting around 18% of women and 13% of men, and the highest in sub-Saharan Africa with 70% of women and 55% of men. 4 - 8 Around 80% of those affected are unaware, but the majority can be taught to recognise symptoms. 9 Although those with a symptomatic presentation may never have another episode, there is a 60% chance that those with HSV1 will have a further episode within the next 12 months with a median time lag of 6 months. Those with a symptomatic presentation of HSV2 do statistically less well with an 80%-90% chance of recurrence within the next year, and a median of four recurrences during this time, having to wait a median of only 2 months until the second episode and recurrences occurring four to six times more frequently than with type 1. 10 11
Yet, for many people with genital herpes, the real suffering is not the reality (or simply the threat) of recurrent painful blistering in the genital area, but the awareness that they may pass the infection on, even when they have no symptoms... it is the perception that they have been transformed into a sexual leper-that there is a risk that they might impose a similar experience on others in any future sexual liaison. This change of one's sexual identity into that of a potential...