Aspects of herpes simplex virus: a clinical review.

©FSRH J Fam Plann Reprod Health Care 2009: 35(4) Introduction Genital herpes (GH) is the most frequent cause of genital ulceration worldwide. It results in a chronic, recurrent viral genital infection. It is caused by herpes simplex virus (HSV), most commonly HSV-2, although an increasing proportion of GH is now caused by HSV-1. Asymptomatic viral shedding accounts for the majority of instances of sexual transmission of HSV-2. Antiviral chemotherapy offers a significant clinical benefit to the majority of symptomatic patients and is the mainstay of management. Counselling regarding the natural history, risk of sexual and perinatal transmission, and methods to reduce transmission are integral to clinical management. Research continues to be undertaken in developing a prophylactic HSV-2 vaccine. Recent attention has focused on the role of HSV-2 as a co-factor for HIV infection and hence HSV-2 treatment may have a role as an HIV prevention strategy. This paper reviews the epidemiology, natural history and diagnosis with emphasis on the management of GH in women and in pregnancy based on the latest guidelines from the British Association for Sexual Health and HIV (BASHH) and the Centers for Disease Control and Prevention (CDC) and recent published literature. It also discusses HSV-2 vaccination and the synergistic interaction between HIV and HSV, which may be driving the HIV epidemic in the developing world.