LIMITING THE SPREAD OF GENITAL HERPES

In many western countries, successful control of bacterial sexually tr ansmitted diseases (STDs) has contrasted with an increase in the preva lence of viral STDs. The continued increase in clinical and subclinica l genital herpes infections is of particular concern because of the im plications for the risk of coincident spread of human immunodeficiency virus infection. Advances in knowledge of the epidemiology and natura l history of genital herpes must be the basis of renewed educational e fforts targeted at the general public, healthcare professionals, as we ll as infected persons. Diagnostic techniques, such as polymerase chai n reaction and type-specific serology, now allow increased detection o f subclinical infection. However, infected persons must be assured of access to effective antiviral treatment and comprehensive holistic man agement if the clinical and epidemiological benefits of detection are to outweigh the psychological and psychosocial disadvantages of being infected with a stigmatized condition. Vaccines could offer the best p rospect for both primary prophylaxis and immunotherapy of genital herp es, and may have the greatest impact in limiting the spread of this in fection. Recent progress has been made in the development of effective and safe vaccines, and their successful introduction should be a majo r priority over the next decade.