Teresa A. Batteiger, MD, MS, Cornelis A. Rietmeijer, MD, PhD
KEYWORDS
Herpes simplex virus (HSV), HSV diagnosis, HSV treatment, HSV counseling
KEY POINTS
- Genital herpes is a very common sexually transmitted infection caused by herpes simplex virus (HSV)-1 or HSV-2.
- Counseling is an important aspect of the management of genital herpes.
- Transmission occurs via sexual contact; the virus can also be transmitted from mother to child during pregnancy or delivery resulting in neonatal herpes infection.
- Molecular virologic tests performed on lesions are the preferred mode of diagnosis. Sero- logic testing can be considered in selected cases based on the clinical scenario.
- Options for treatment of genital herpes include acyclovir, valacyclovir, and famciclovir. The duration of therapy for primary infection is longer than for recurrent outbreaks. Sup- pressive therapy can be used to decrease frequency of outbreaks and decrease risk of transmission.
INTRODUCTION
Genital herpes is a chronic, lifelong sexually transmitted viral infection, which can cause recurrent, self-limited genital ulcers. It is caused by herpes simplex virus (HSV) type 1 and type 2 viruses. HSV-1 can cause both oral and genital infection but is mostly associated with oral lesions (herpes labialis). HSV-2 is the leading cause of genital ulcer disease and increases risk for HIV acquisition two- to threefold. Although it can cause oral lesions in rare instances, HSV-2 almost exclusively causes genital infections and is more commonly associated with recurrent outbreaks. Most of the people infected with genital herpes are unaware of their status. A National Health and Nutrition Examination Survey (NHANES) found that only around 13% of HSV-2 seropositive individuals had been diagnosed with genital herpes.5 However, these individuals can still shed virus intermittently. Genital HSV is commonly encoun- tered by primary care clinicians. Here, the authors review epidemiology, diagnosis, and management of genital herpes, illustrated by clinical vignettes and focusing on common patient questions.