Recent advances in genital herpes.
The majority of transmissions occur as a consequence of inapparent infection in the source contact, as asymptomatic viral excretion in individuals with recurrent infection. The development of type specific serological assays has allowed for a more accurate determination of herpes simplex virus (HSV) 2 prevalence and has revealed that the prevalence of HSV 2 in sexually transmitted disease clinic attenders varies from 8%-83%, in female prostitutes from 75%-96% and in antenatal clinic attenders from 6%-53%. The majority of individuals (+/-60%) exposed to HSV 2 do not develop any symptoms. Patients treated for primary genital herpes are likely to resume sexual intercourse earlier than those who do not. Long-term suppressive acyclovir will result in decrease in clinical symptoms and viral excretion and may decrease the opportunity for HSV transmission. Acyclovir is the drug of choice for the treatment of primary genital herpes and for long-term acyclovir suppression. Two new drugs, valaciclovir and famciclovir, are currently under investigation. Failure to respond to acyclovir may be due to inadequate dose, malabsorption, another condition, or resistance. Resistance is rare and occurs mainly in profoundly immunosuppressed individuals, and is usually due to the development of thymidine kinase deficient mutants. Treatment with intravenous foscarnet is usually successful. Patients with genital herpes have a number of emotional problems, particularly if the condition recurs. Recent studies suggest that emotional stress does not precipitate recurrences, but rather recurrences cause stress. Long-term acyclovir suppression can decrease psychological morbidity in patients with frequent recurrences.
Mindel
A
A
Academic Unit of Sexual Health Medicine, Sydney Hospital, NSW, Australia.
D000293:Adolescent; D000328:Adult; D005260:Female; D006558:Herpes Genitalis / Q000188:drug therapy / Q000523:psychology / Q000635:transmission; D006801:Humans; D008297:Male