Asian guidelines for genital herpes

Abstract

Prevention1. Regular male condom usage effectively reduces the transmission risk of genital HSV-2 infection (LE: 2A, GR: B); there is no added advantage of the vaginal diaphragm (LE: 1B, GR: A).2. The evidence is mixed regarding circumcision as a preventive measure against genital herpes in males and their spouses.3. Oral valacyclovir (but not acyclovir) and vaginal tenofovir 1 % gel have been shown to reduce the risk of sexual transmission in susceptible partners and women, respectively (LE: 1B, GR: A).4. Limited data on the use of anti-HSV vaccines suggests that it is not significantly effective in preventing genital herpes (LE: 1B, GR: B).Diagnosis 1. Tzanck smear is a rapid point-of-care test that yields quick results but is highly operator skill-dependant. (LE: 3) 2. Virus antigen can be detected using either DIF or antigen capture EIA. (LE: 3). It is recommended to perform HSV typing in patients with first-episode genital herpes. (LE: 3) 3. Viral culture has been traditionally considered the 'Gold standard' in diagnosing genital herpes. (LE: 4) 4. PCR is more sensitive than viral culture. (LE: 1B) It is widely regarded as the test of choice for the diagnosis of genital herpes in symptomatic patients. (LE: 4) 5. Serology: Seroconversion or a rising titre of antibodies has diagnostic significance. (LE: 2A) Type-specific assays which detect IgG antibodies against antigenically unique glycoproteins G1 and G2 should be used. (LE: 3). TreatmentFirst episode genital herpes 1 Oral acyclovir, valacyclovir and famciclovir are similarly effective in reducing the severity and duration of symptoms (LE: 1A, GR: A). Topical antivirals are not effective in reducing symptoms (LE: 1A, GR: A), and topical acyclovir is associated with resistance to oral acyclovir (LE: 3, GR:B).