GENITAL HERPES INFECTION - A REVIEW

Genital herpes infection is life-long and may result in painful and re current genital lesions, systemic complications, serious psychosocial morbidity, and rare but serious outcomes in neonates born to infected women, including permanent neurological handicap and death, Herpes sim plex virus (HSV)-2 is the principal cause, with an increasing proporti on of first-episode disease caused by HSV-1. Genital HSV transmission is usually due to asymptomatic viral shedding by people who are unawar e that they are infected and clinical screening fails to detect most i nfections, Type-specific serological assays can distinguish the two vi ral subtypes, hut these are expensive and currently restricted to a fe w research settings. Most infections are asymptomatic, or cause a mild illness which does not lead to health service attendance; but the lim ited evidence suggests a rise in disease incidence, perhaps related to a fall in HSV-I age-specific prevalences. The prevalences of HSV geni tal infections increase with age and numbers oi sexual partners, with higher rates in specific ethnic and low socioeconomic groups, However, infection is not restricted to high-risk populations. Antiviral agent s, such as acyclovir, can reduce disease severity, prevent recurrences and shorten periods of viral shedding, but currently there are no eff ective population control measures. This may change with the advent of HSV vaccines, ii their safety and long-term efficacy are confirmed, P ossible applications for vaccines may include the suppression of disea se and recurrences in patients with genital infections (immunotherapy) , the prevention of viral transmission to their seronegative partners, and immunoprevention through vaccinating the latter, Economic evaluat ions of existing and potential control strategies, age-specific popula tion HSV-1 and 2 seroprevalence studies for targeting future intervent ions, and cohort studies to elucidate the natural history of HSV-2 inf ections are needed.