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.
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- 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
- SUMMARY AND RECOMMENDATIONS