Challenges in Genital Herpes Simplex Virus Management

Abstract

Development of serologic assays to detect antibodies to herpes simplex virus (HSV) glycoproteins (g)G1 and (g)G2 has allowed accurate definition of the seroprevalence of HSV-2 worldwide. Studies from all continents indicate epidemic proportions of HSV-2 infection. In the United States, 1 in 5 sexually active adults is infected. In Africa and the Caribbean, HSV prevalence is higher. Since the development of the acyclic nucleoside derivatives acyclovir, famciclovir, and valacyclovir, treatment of mucocutaneous HSV is a practice of everyday medical care. Yet, despite effective drugs, there is widespread discontent by clients and providers about care of patients with genital herpes. Much of this relates to transmission complexities and the varied natural history of the infection. However, over time, most patients adjust to their disease and the medical and psychosocial complications. Recent studies show condoms reduce transmission, providing an important tool for counseling the patient with newly diagnosed genital herpes. Genital Herpes: Patient Management IssuesThe number of persons with genital herpes simplex virus (HSV) infections has reached epidemic proportions worldwide, and physicians and patients alike face major challenges in managing the disease and preventing further spread of the virus [1][2][3][4][5][6][7][8][9][10][11]. Many of these conclusions are from seroepidemiologic studies that have used newly developed serologic assays that measure antibodies to glycoprotein (g)G1 and (g)G2, for HSV-1 and HSV-2, respectively. These assays accurately differentiate past HSV-1 from HSV-2 infection, allowing investigators to define the seroprevalence of these infections in a wide variety of populations (table 1) [12][13][14][15]. Data from these studies show an ever-increasing trend. For example, in the United States, the prevalence of HSV-2 in the general population is currently 21%, an increase of over 30% since AIDS was discovered [1].All social strata are affected by the increase in HSV infections. In Europe, contrary to clinical impressions, HSV-2 now is found in 8%-15% of the general population and in 25%-40% of persons with sexually transmitted diseases (STDs) [7, 8, While the seroprevalence of infection has increased in the last quarter of a century, so has the physicians' ability to treat genital herpes. One of the most significant developments of the last 20 years has been development of effective antiviral therapies for the treatment of HSV-1 and HSV-2 [22][23][24][25][26][27]. The acyclic nucleoside, acyclovir, and the derivative compounds valacyclovir, famciclovir, and penciclovir have revolutionized antiviral chemotherapy [28][29][30][31][32][33]. These drugs are effective and well tolerated for management of HSV-2 infections; therapy shortens the duration of outbreaks and prevents complications of first-episode infections, such as meningitis and radiculitis. Recent studies show the effectiveness of long-term suppression of HSV in preventing reactivation both clinically and subclinically [34]. Acyclo...

Acyclovir Reduces the Duration of Fever in Patients with Infectious Mononucleosis-like Illness

“…Antiviral therapy with high-dose acyclovir reportedly led to a reduction in the mortality of infants with disseminated disease (Corey and Wald 2009). The number of genital HSV infections among adults has increased in the last 30 years (Corey 2002). Varicella zoster virus (VZV), which belongs to the subfamily Alphaherpesvirinae, is commonly treated by nucleosides such as acyclovir, famciclovir, and valacyclovir (Rajan and Rivers 2001).…”

Inhibition of Herpes Simplex Virus Types 1 and 2 In Vitro Infection by Sulfated Derivatives of Escherichia coli K5 Polysaccharide

“…In particular, genital herpes (generally caused by HSV type 2 [HSV-2], but also by HSV-1) is characterized by a high seroprevalence worldwide (8 to 40%), with an increasing trend in the last 20 years in nearly all countries (8,16,26). Among the high-risk population, HSV-2 infection, the most frequent cause of genital ulcer disease, is a major public health problem in young adults (13).…”

Recombinant herpesviruses as tools for the study of herpesvirus biology

“…Recurrence in immunocompromised hosts however tends to be serious. Recurrent ocular herpes is the leading cause of corneal blindness, and genital herpes is one of the most common sexually transmitted diseases in industrialized countries (Liesegang, 2001;Corey, 2002). The virus is also the causative agent of life-threatening diseases such as herpes encephalitis and neonatal herpes (Kúdelová and Rajčáni, 2013).…”