Genital Herpes Simplex Virus Type 1 in a Multiethnic Urban STD Clinic

Background: Genital Herpes Simplex Virus (HSV) infection is the most common cause of genital ulcerative disease. Most genital infections are caused by HSV-2 but HSV-1 is emerging as an important cause of genital herpes in certain populations.

Objectives: To describe the characteristics of individuals presenting with genital HSV-1 in the Miami Dade Health department STD clinic.

Methods: Records from all individuals with HSV detected from a genital culture collected from 2008 to 2010 were reviewed. Primary genital HSV-1 infection was defined by a positive culture for HSV-1 and negative serology. Recurrent genital HSV-1 was defined by a positive culture and positive serology.

Results: Three hundred and fifteen individuals had a positive HSV culture. Twenty-nine (9.2%) of them had genital HSV-1: fifteen were male and fourteen were female. The median age was 24 years. Twelve (41.3%) were African-American, 13 (44.8%) were Hispanic white and 3 (10.3%) were Non-Hispanic whites. The majority of the individuals reported only heterosexual contacts (28, 96.5%) and engaged in oral sex (26, 89.6%). Condom use in the last sexual encounter was low (5, 17.2%). Prior STIs were reported by 13 subjects (44.8%) and 6 (20.7%) had a concurrent non-ulcerative STI. Ten individuals had serology performed, 8 (80%) were confirmed as having primary HSV infection and 2 had recurrent infection (20%). Co-infection with HIV was present in one subject.

Conclusions: HSV-1 is an infrequent cause of genital ulcerative disease in our multiethnic urban STD clinic. It was primarily seen in young heterosexual individuals with high rates of prior and concurrent STIs and low rates of condom use. 

Implications for Programs, Policy, and Research: The epidemiologic data extracted from this population should serve to identify individuals at risk for HSV-1 and to alert health care providers to consider HSV-1 genital disease as an important cause of ulcerative genital disease.