Genital herpes

Genital herpes simplex virus (HSV) infections are common. In both developed and developing countries, the incidence of infection appears to be increasing. The epidemiology of HSV is shifting, and new genital infections are increasingly with HSV-1. Such infections are indistinguishable from HSV-2 infections. Acquisition episodes are often asymptomatic and many individuals are unaware of their infection status. Recurrences are more common with HSV-2 genital disease, and almost all carriers will experience a recurrence, posing a potential risk of onward transmission. Acquisition episodes can be severe and complicated. Recurrences may be severe, frequent and associated with a range of complications including psychosexual disturbances. Management requires anticipation of these problems and includes careful patient assessment, timely antiviral therapy, informed counselling and patient education. Many patients fear onward transmission, and clinicians must be aware of the benefits and limitations of the various strategies to manage this risk. Education, counselling, condom promotion and antiviral drugs all appear to have a role. Many epidemiological studies have found close links between the presence of HSV genital infections and increased risk of HIV acquisition and onward transmission. These links are being investigated and may enable development of interventions to manage HIV spread through HSV control.