Prevention of genital herpes virus infections
- Anna Wald, MD, MPH
Anna Wald, MD, MPH
- Professor of Medicine, Epidemiology, and Laboratory Medicine
- University of Washington
Prevention of genital herpes simplex virus (HSV) infections can avert significant morbidity associated with primary infection and the ongoing discomfort and psychological distress that may occur with recurrences. Preventive measures include patient education, use of barrier protection, and chronic suppressive therapy.
This topic will address measures that are available to prevent HSV transmission. The epidemiology, clinical manifestations, diagnosis, and treatment of HSV infection are discussed elsewhere. (See "Treatment of genital herpes simplex virus infection" and "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection".)
COUNSELING AND EDUCATION
Counseling is important for the effective management of the patient with genital HSV, particularly in the setting of a primary or first recognized clinical episode. Many questions invariably arise at the time of diagnosis as to the expected frequency and severity of recurrences and the potential for transmission to others.
Psychological aspects of HSV infection can be distressing for patients, but may be under-appreciated by the clinician. A diagnosis of HSV may evoke anger, disbelief, low self-esteem, and fear of rejection by present and future sexual partners . It is important for the clinician to openly address all of these issues.
Anger is often directed at the current partner and questions regarding partner infidelity may arise at the time of diagnosis. However, the first diagnosed outbreak does not necessarily imply new acquisition . Patients should be counseled that this may be the first recognized outbreak; only serologic testing in concert with virologic testing of the lesions can determine if their current episode represents newly acquired infection.
- Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370:2127.
- Reeves WC, Corey L, Adams HG, et al. Risk of recurrence after first episodes of genital herpes. Relation to HSV type and antibody response. N Engl J Med 1981; 305:315.
- Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med 1999; 131:14.
- Langenberg AG, Corey L, Ashley RL, et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. N Engl J Med 1999; 341:1432.
- Barton SE. Reducing the transmission of genital herpes. BMJ 2005; 330:157.
- Gottlieb SL, Douglas JM Jr, Foster M, et al. Incidence of herpes simplex virus type 2 infection in 5 sexually transmitted disease (STD) clinics and the effect of HIV/STD risk-reduction counseling. J Infect Dis 2004; 190:1059.
- U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149:491.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Wald A, Krantz E, Selke S, et al. Knowledge of partners' genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis 2006; 194:42.
- Hook EW, Leone P. Time to translate new knowledge into practice: a call for a national genital herpes control program. J Infect Dis 2006; 194:6.
- Wald A, Zeh J, Selke S, et al. Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med 2000; 342:844.
- Wald A, Ashley-Morrow R. Serological testing for herpes simplex virus (HSV)-1 and HSV-2 infection. Clin Infect Dis 2002; 35:S173.
- Corey L. Challenges in genital herpes simplex virus management. J Infect Dis 2002; 186 Suppl 1:S29.
- Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 2001; 285:3100.
- Wald A, Langenberg AG, Krantz E, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med 2005; 143:707.
- Magaret AS, Mujugira A, Hughes JP, et al. Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples. Clin Infect Dis 2016; 62:456.
- Hook EW 3rd. An ounce of prevention. Ann Intern Med 2005; 143:751.
- Rana RK, Pimenta JM, Rosenberg DM, et al. Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes. Sex Transm Infect 2006; 82:69.
- Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med 2004; 350:11.
- Mujugira A, Magaret AS, Celum C, et al. Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons: a randomized controlled trial. J Infect Dis 2013; 208:1366.
- Johnston C, Saracino M, Kuntz S, et al. Standard-dose and high-dose daily antiviral therapy for short episodes of genital HSV-2 reactivation: three randomised, open-label, cross-over trials. Lancet 2012; 379:641.
- Gupta R, Wald A, Krantz E, et al. Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract. J Infect Dis 2004; 190:1374.
- Wald A, Selke S, Warren T, et al. Comparative efficacy of famciclovir and valacyclovir for suppression of recurrent genital herpes and viral shedding. Sex Transm Dis 2006; 33:529.
- Crosby RA, Head S, DiClemente RJ, et al. Do protective behaviors follow the experience of testing positive for herpes simplex type 2? Sex Transm Dis 2008; 35:787.
- Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 2006; 82:101.
- Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009; 360:1298.
- Corey L, Bodsworth N, Mindel A, et al. An update on short-course episodic and prevention therapies for herpes genitalis. Herpes 2007; 14 Suppl 1:5A.
- Celum C, Morrow RA, Donnell D, et al. Daily oral tenofovir and emtricitabine-tenofovir preexposure prophylaxis reduces herpes simplex virus type 2 acquisition among heterosexual HIV-1-uninfected men and women: a subgroup analysis of a randomized trial. Ann Intern Med 2014; 161:11.
- Abdool Karim SS, Abdool Karim Q, Kharsany AB, et al. Tenofovir Gel for the Prevention of Herpes Simplex Virus Type 2 Infection. N Engl J Med 2015; 373:530.
- Bender Ignacio RA, Perti T, Magaret AS, et al. Oral and Vaginal Tenofovir for Genital Herpes Simplex Virus Type 2 Shedding in Immunocompetent Women: A Double-Blind, Randomized, Cross-over Trial. J Infect Dis 2015; 212:1949.
- Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis 1998; 26:541.
- Rouse BT, Kaistha SD. A tale of 2 alpha-herpesviruses: lessons for vaccinologists. Clin Infect Dis 2006; 42:810.
- Belshe RB, Leone PA, Bernstein DI, et al. Efficacy results of a trial of a herpes simplex vaccine. N Engl J Med 2012; 366:34.
- Corey L, Langenberg AG, Ashley R, et al. Recombinant glycoprotein vaccine for the prevention of genital HSV-2 infection: two randomized controlled trials. Chiron HSV Vaccine Study Group. JAMA 1999; 282:331.
- Stanberry LR, Spruance SL, Cunningham AL, et al. Glycoprotein-D-adjuvant vaccine to prevent genital herpes. N Engl J Med 2002; 347:1652.
- Straus SE, Corey L, Burke RL, et al. Placebo-controlled trial of vaccination with recombinant glycoprotein D of herpes simplex virus type 2 for immunotherapy of genital herpes. Lancet 1994; 343:1460.
- Straus SE, Wald A, Kost RG, et al. Immunotherapy of recurrent genital herpes with recombinant herpes simplex virus type 2 glycoproteins D and B: results of a placebo-controlled vaccine trial. J Infect Dis 1997; 176:1129.
- de Bruyn G, Vargas-Cortez M, Warren T, et al. A randomized controlled trial of a replication defective (gH deletion) herpes simplex virus vaccine for the treatment of recurrent genital herpes among immunocompetent subjects. Vaccine 2006; 24:914.
- COUNSELING AND EDUCATION
- Reducing risk of transmission
- Determining partner susceptibility to infection
- Educational resources
- DISCLOSURE OF HSV STATUS TO SEXUAL PARTNERS
- AVOIDANCE OF SEXUAL ACTIVITY DURING DISEASE
- CONDOM USE
- CHRONIC SUPPRESSIVE THERAPY IN DISCORDANT COUPLES
- Effect on transmission
- Clinical decision making
- - Immunocompetent patients
- - Immunocompromised patients
- Choice of agent
- Identification of HSV serostatus
- Duration of therapy
- Laboratory monitoring
- Treatment interruptions
- STD SCREENING
- CIRCUMCISION STATUS
- INVESTIGATIONAL APPROACHES
- VACCINE DEVELOPMENT
- Immunogenicity and protective efficacy
- Therapeutic vaccine
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS