What Are the Physical Effects and Possible Complications?
People who have normal immune systems typically have the symptoms already mentioned. Those undergoing chemotherapy for leukemia or lymphoma, those with HIV or AIDS, and those born with poor immune systems (SCID, DiGeorge Syndrome, etc.) will often have much more severe presentations. Examples include ulcers in a wider distribution than normal, larger-than-normal ulcers, and ulcers that heal poorly or not at all.
A rare complication (only 1 in 500,000 people) is a brain infection called herpes simplex encephalitis. However, this is usually associated with HSV-1, which usually causes oral herpes or in neonatal herpes virus infections.
Perhaps one of the most feared consequences of genital herpes infections is infection of a newborn, or neonatal infection. Unlike genital herpes infections in adults, neonatal herpes can have very grave outcomes, including death. The incidence is between 1 in 2,000 and 1 in 10,000 live births, and the incidence is higher in premature births than in full-term births. The risk of infecting the neonate is 10 times greater if the mother is newly infected with the herpes virus (a primary infection, as opposed to a secondary outbreak) during the baby’s. Infection occurs either by spread of HSV-2 up the mother’s genital tract or during passage through the mother’s infected genital tract during birth.
Neonatal infection becomes apparent several days to several weeks after birth with a widespread infection (sepsis), eye infection (conjunctivitis), seizures, lethargy and coma as possible symptoms.
Women without any history of genital herpes, without any signs or symptoms (including prodrome) of genital herpes, and with a negative genital examination around the time of labor may deliver vaginally.
Women who have a history of genital herpes, especially late in pregnancy, or who have a partner with genital herpes should have cultures taken of the birth canal to help decide the best mode of delivery. Women who have active herpes lesions at the time of labor will usually undergo a caesarean section to reduce the likelihood of neonatal infection.