Genital Herpes: Management Issues for the Next Century

Abstract

Genital herpes (GH) is caused by herpes simplex virus (HSV) types 1 and 2. HSV-2 is more commonly the causal agent, and is responsible for 98% of recurrences. A first episode may become clinically apparent within 2–21 days post-infection. Symptomatic recurrences present as vesiculo-ulcerative lesions, which typically resolve within 5 days. The overall recurrence rate for GH is 60–90%. Asymptomatic shedding occurs in both sexes on 1–5% of days. Aciclovir, famciclovir and valaciclovir are the approved drugs for GH, and one of these should be used in all first episodes. Episodic treatment is often used where recurrences are infrequent and easily recognized. Oral treatment with famciclovir, aciclovir or valaciclovir reduces the duration of lesions, viral shedding and uncomfortable symptoms. Patients with frequent or problematic recurrences are candidates for prophylaxis with antivirals which suppress both symptomatic and asymptomatic reactivation. A herpes diagnosis often leaves patients emotionally vulnerable, concerned about asymptomatic shedding and fearful of transmission to sexual partners. GH can be devastating, occasionally leading to clinical depression and/or suicidal ideation. Patients commonly fear discussing GH with their physician or partners, but doing so is vitally important for their psychological health. Counselling to assist in this process is helpful. In summary, good management of GH requires careful attention to proper diagnosis and therapy, with psychosocial intervention: all three provided in the context of accurate information.