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Treatment of genital herpes simplex virus type 2 in HIV-infected patients

Christine Johnston, MD, MPH
Anna Wald, MD, MPH
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Genital herpes is a common sexually transmitted virus infection that is found worldwide. Genital herpes is usually secondary to herpes simplex virus type 2 (HSV-2); the remainder of infections is related to HSV-1, which also causes herpes labialis ("cold sores") [1]. The seroprevalence of HSV-2 infections in HIV-infected patients is high (50 to 90 percent) and genital ulcer disease can be more frequent, severe, and of longer duration than in HIV-seronegative patient populations [1].

This topic will review the treatment of genital herpes in HIV-infected patients. The natural history, clinical manifestations, and prevention of genital HSV infection in the HIV-infected patient and important viral interactions between HIV and HSV-2 are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus in HIV-infected patients".)


There are three classification categories for genital herpes, as noted below.

Primary HSV infection — An HSV outbreak is defined as "primary" if the patient was HSV-seronegative for both HSV-1 and HSV-2 at the onset of genital lesions.

Nonprimary HSV infection — Nonprimary first episode infection refers to: a) the acquisition of genital HSV-1 infection in a patient with preexisting antibodies to HSV-2 or b) the acquisition of genital HSV-2 infection in a patient with preexisting antibodies to HSV-1 (eg, an individual with prior orolabial herpes). Most HIV-infected adults with a new diagnosis of HSV infection have nonprimary disease due to prior acquisition of HSV-1 infection.

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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