Aspects of herpes simplex virus: a clinical review

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. Search methodsThis review is based on PubMed and MEDLINE searches for GH over the past 17 years (1990 to February 2007).Search terms used were "genital herpes, HSV, HSV epidemiology, HSV vaccine" with the limits metaanalyses, randomised controlled trial (RCT) and review.Other sources of information included the Health Protection Agency (HPA) and World Health Organization (WHO) websites and revised guidelines and recommendations of BASHH (2007), CDC (2006) and the International Herpes Management Forum.Additional data were obtained from recent international meetings and personal experience of treating patients with GH. EpidemiologyHSV is a double-stranded DNA virus that forms part of the alpha herpesviridae subfamily of viruses.HSV exists as two types, type 1 and 2, which are distinguished by antigenic differences in their envelope proteins.HSV infection results in lifelong infection, which can be asymptomatic or present with recurrent lesions.A significant proportion of patients with GH fail to recognise their symptoms as clinical signs as these can be very subtle.