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.

Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management

“…23,67 HSV1-induced genital infections are typically milder and less recurrent compared with those caused by HSV2. 11,24,26,42,52,107 HSV2-induced genital herpes is 6 times more frequent than those caused by HSV1. 95 In contrast, a majority of oral herpes reactivations are J AM ACAD DERMATOL VOLUME 57,NUMBER 5 caused by HSV1; HSV2 recurrence in the oral cavity is uncommon.…”

“…83 Compared with primary infections, recurrent episodes are milder and shorter in duration with minimal systemic involvement. 9,25,42,50 The severity of recurrent facial herpes infection covers a broad spectrum, ranging from minimal discomfort to extensive, symptomatic, unsightly involvement of the lips, cheeks, nose, and nasal septum. 49,84 In healthy hosts, recurrent lesions remain localized to the mucodermatome of primary infection and often lead to mild discomfort.…”

“…5,9,[11][12][13]25,26,[35][36][37][38] Demographics HSV1 accounts for the majority of nongenital HSV-induced infections in humans, 39 with 45% to 98% of the world population and 40% to 63% of the people in the United States reportedly HSV1 seropositive. 32,[40][41][42] Worldwide HSV1 prevalence varies with age, race, geographic location, and socioeconomic status; a higher rate of seropositivity has been reported for less industrialized countries. 11,26,[43][44][45][46][47] By the age of 60, 60% to 85% of adults in the United States demonstrate HSV1 seroconversion.…”

Challenges in anti-infective therapy for skin conditions: part 1

“…Although primary genital disease from HSV-1 and HSV-2 are clinically indistinguishable in appearance, severity and duration [111,112], HSV-1-induced genital infections are typically milder and less recurrent compared with those caused by HSV-2 [113][114][115][116]. While a majority of oral herpes reactivations are caused by HSV-1, HSV-2 recurrence in the oral cavity is uncommon.…”