Genital Herpes

Academic Article

Abstract

  • All patients with a first clinical episode of genital herpes, such as the patient in the vignette, should be treated for 7 to 10 days with systemic antiviral therapy (acyclovir, valacyclovir, or famciclovir). Therapy should be extended if healing is incomplete after 10 days of therapy. After this treatment, patients should be educated about the potential benefits of suppressive therapy and offered this treatment. Counseling should include discussion of the risk of frequent recurrences during the next few years if suppressive therapy is not used, as well as the benefits of suppressive therapy in preventing transmission to uninfected partners. The choice of drug will depend on cost, convenience, and formulation. Lesions should be cultured for HSV. However, treatment for clinically suspected disease should not be delayed pending the culture result. Because false negative HSV cultures can occur in patients with recurrent infection or with healing lesions, type-specific serologic testing should be performed at the time of an initial episode and, if negative, repeated three months later. Type-specific serologic analysis can also aid in the classification of infection as primary, nonprimary, or recurrent, and thus may guide counseling. Possible concerns regarding infidelity should be addressed directly. Patients should understand that many first clinical episodes of symptomatic genital herpes actually represent recurrent infection and that a new diagnosis of genital herpes in a member of a monogamous couple does not necessarily imply recent acquisition of infection from another partner. If suppressive therapy is begun, patients should be asked approximately yearly whether they wish to continue it. The frequency of genital recurrences decreases over time for both patients who receive suppressive therapy and those who do not, and a drug holiday allows for reassessment of whether suppression is still needed. All persons with genital herpes should be educated about the risk of transmission to partners, even when they are asymptomatic. Serologic testing and counseling of current partners should be offered, if appropriate. HSV-infected patients with seronegative partners should be counseled to refrain from sexual intercourse during clinical recurrences, encouraged to use condoms, and offered antiviral suppression to decrease the risk of transmission. However, they should also understand that the risk of transmission is not completely eliminated even with these approaches.
  • Published In

    Digital Object Identifier (doi)

    Author List

  • Kimberlin DW; Rouse DJ
  • Start Page

  • 1970
  • End Page

  • 1977+2017
  • Volume

  • 350
  • Issue

  • 19