New developments in the epidemiology, natural history and management of genital herpes

The prevalence of genital herpes is increasing in several populations world wide. Factors that may be contributing to this increase include greater num bers of sexual partners, the high frequency of asymptomatic infections, poo r use of safe sexual practices, and possibly the decreased incidence of chi ldhood oral herpes simplex virus infection. Transmission occurs via skin-to -skin or mucous membrane contact during periods of viral shedding when lesi ons are present but may also occur when the patient is unaware of the lesio ns or when lesions are not clinically apparent. This has important implicat ions for strategies to prevent transmission of the disease. The introductio n of the antiherpes agent, acyclovir, and more recently famciclovir and val acyclovir, facilitates the management of genital herpes. Treatment of first -episode genital herpes reduces the severity and duration of symptoms, time to lesion healing, and cessation of viral shedding. Episodic treatment of recurrences as they occur may be of benefit to some patients. Daily suppres sive therapy significantly reduces the frequency of recurrences and asympto matic viral shedding. Accordingly, patients who experience frequent or seve re recurrences, those particularly troubled by their disease, and those who wish to reduce the frequency of asymptomatic infection generally prefer su ppressive therapy. The possibility that suppressive therapy may have an imp act on transmission of the disease is currently under investigation. Antivi ral treatments have important implications for public health and may help r educe the psychological and psychosocial impact of genital herpes on indivi dual patients. (C) 1999 Elsevier Science B.V. All rights reserved.