Epidemiology Studies have found that up to 1 in 5 adults have evidence of HSV-2 infection. Most of these people have either no or only very mild symptoms, such that they are unaware of having been infected. Thus, sexual contact, including oro-genital contact, is the most common way to transmit genital HSV infection. The virus can be shed in saliva and genital secretions from individuals, even if they have no symptoms, especially in the days and weeks following a clinical episode. The amount shed during active lesions is 100 to 1000 times greater.
Minor injury helps spread the virus, especially into the skin.
Appearances of initial infections First infections may be mild and unnoticed, but should lesions develop, the severity is generally greater than in recurrences. Penile ulceration from herpetic infection is the most frequent cause of genital ulceration seen in sexual health clinics. The ulcers are most frequent on the glans, foreskin and shaft of the penis. They are sore or painful and last for 2 to 3 weeks if untreated. The local lymph glands are enlarged and tender.