Genital herpes

Human α-herpesvirus infections are characterized by initial primary infections of variable severity followed by a period of neuronal latency that is interrupted by reactivation. Both the acquisition illness and the recurrent disease may become complicated. Although many individuals with genital herpes are relatively problem free, herpes simplex virus (HSV) infections can cause a wide range of problems. Troublesome symptoms can be managed effectively with antiviral therapy. For those individuals with relatively well-defined tolerable prodromes or occasional recurrences, and who do not have complicated disease, episodic therapy offers a useful alternative to continuous suppressive treatment. It was recently demonstrated that short courses of therapy with valaciclovir, aciclovir or high-dose famciclovir are as effective as longer courses of episodic therapy. However, for many patients, suppressive therapy remains the most effective means of managing their problems. Not only will continuous therapy control lesions and prodromal symptoms, it can also be highly effective at managing psychosexual problems and transmission risk. The management of HSV infection in pregnancy can be challenging. Third-trimester new infections are extremely hazardous and clear guidelines on planned caesarean section should be followed. The management of women with recurrent disease is more controversial. Recurrences at term are associated with neonatal disease (up to 3% transmission) and can result in substantial anxiety. HSV infections remain an extremely active area of research. New work shows the important role of genetic predisposition in determining the occurrence of severe neurological dissemination and the possibility of targeting new sites within the genome to effect better treatment.