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Treatment of genital herpes simplex virus infection

Author
Mary A Albrecht, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Genital herpes simplex is a common sexually transmitted virus infection that is found worldwide. Most of these genital infections are caused by herpes simplex virus-2 (HSV-2), but herpes simplex virus-1 (HSV-1) also produces a clinically similar disease. Antiviral therapy can shorten the duration of symptoms and signs in primary infection which, when untreated, can be associated with significant morbidity. Clinical recurrences are also common and can be treated episodically or prevented with continual antiviral suppression.

This topic review addresses the natural history of genital HSV infection, clinical recurrences, and data supporting treatment efficacy of primary and repeated episodes of infection. The epidemiology, clinical manifestations, and diagnosis of genital HSV infection and issues related to pregnancy are presented separately. (See "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection" and "Genital herpes simplex virus infection and pregnancy" and "Prevention of genital herpes virus infections".)

NATURAL HISTORY OF INFECTION

Primary infection — An HSV outbreak is defined as "primary" if the patient was HSV-seronegative for both HSV-1 and HSV-2 before the episode of genital lesions. The primary episode of genital HSV infection can be associated with a multitude of constitutional symptoms and signs, such as fever, malaise, and headache. In addition to painful genital lesions, dysuria can be severe. Symptoms may last two to four weeks if left untreated. (See "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection" and "Genital herpes simplex virus infection and pregnancy".)

Nonprimary infection — Nonprimary episode infection refers to HSV-2 infection in a person with preexisting HSV-1 immunity [1]. The signs and symptoms of nonprimary infection tend to be less severe than in the person without any existing HSV antibodies.

Recurrent symptomatic disease — Although treatment during primary infection lessens morbidity, it does not eradicate latent virus, which can subsequently reactivate. Genital HSV infection often leads to frequent clinical recurrences, although the risk of genital recurrence is lower in those infected with HSV-1 versus HSV-2 [2]. In the absence of suppressive antiviral therapy, the median recurrence rate after the first episode of HSV-2 infection is about four recurrences a year, with about 40 percent of patients having at least six recurrences and 20 percent having more than 10 recurrences in the first year [1,3]. In contrast, recurrences of HSV-1 occur much less frequently (approximately once per year). Over time, recurrences due to either viral type generally decrease in number and severity, although there is substantial variability in the clinical course from patient to patient [3,4].

                                              

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 07 00:00:00 GMT 2015.
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