European Clinics in Obstetrics and Gynaecology

, Volume 2, Issue 4, pp 191–196

The clinical management of genital herpes

Clinical Review


Genital herpes infections may be caused by either the herpes simplex virus type 1 or 2 (HSV-1 or HSV-2). The changing patterns of HSV-1 acquisition in childhood have meant that many individuals will acquire this disease in adult life when at least one third of such late infections will involve the genital area. In many parts of the world, HSV-1 is the principal cause of acquisition of HSV disease. However, the majority of cases of frequent and severe genital disease remain due to HSV-2. The management of genital HSV infections involves a careful assessment of the impact of the disease upon the patient. Such an assessment must take into consideration not only the severity and frequency of the disease, but also the impact of infection upon the patient’s psychosexual well-being as well as any concerns around the management of transmission to partners or neonates. Antiviral therapy, if indicated, can be carefully tailored to maximize its impact on symptoms, complications or concerns.


Herpes simplex virus Genital herpes Management 


  1. 1.
    Lowhagen GB, Tunback P, Andersson K, Bergstorm T, Johnnisson G (2000) First episodes of genital herpes in a Swedish STD population: a study of epidemiolgy and transmission by the use of herpes simplex virus (HSV) typing and specific serology. Sex Transm Infect 76(3):179–182PubMedCrossRefGoogle Scholar
  2. 2.
    Benedetti J, Zeh J, Corey L (1999) Clinical reactivation of genital herpes infection decreases in frequency over time. Ann Intern Med 131:14–20PubMedGoogle Scholar
  3. 3.
    Kolle DM, Benedetti J, Langenberg A, Corey L (1992) Asymptomatic reactivation of herpes simplex virus in woman after the first episode of genital herpes. Ann Intern Med 116:433–437Google Scholar
  4. 4.
    Wald A (2004) Herpes simplex virus type 2 transmission: risk factors and virus shedding. Herpes 11(Supp 3):130A–137APubMedGoogle Scholar
  5. 5.
    Benedetti J, Corey L, Ashley R (1994) Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Inter Med 121(11):847–854Google Scholar
  6. 6.
    Malkin JE (2004) Epidemiology of genital herpes simplex virus infection in developed countries. Herpes 11(Supp 1):2A–23APubMedGoogle Scholar
  7. 7.
    Kimberlin DW, Rouse DJ (2004) Clinical practice: genital herpes. N Engl J Med 350:1970–1977PubMedCrossRefGoogle Scholar
  8. 8.
    Geretti A, Brown D (2005) National survey of diagnostic services for genital herpes. Sex Transm Infect 81:316–317PubMedCrossRefGoogle Scholar
  9. 9.
    Greenberg RN et al (1984) Overview of patient compliance with medication dosing. Clin Ther 6:592–599PubMedGoogle Scholar
  10. 10.
    MMWR (2006) STD treatment guidelines, vol 55, no. RR11. CDC, Aug 4, 2006Google Scholar
  11. 11.
    Corey L, Fife KH, Benedetti JK et al (1983) Intravenous aciclovir for the treatment of primary genital herpes. Ann Intern Med 98:914–921PubMedGoogle Scholar
  12. 12.
    Richman RC, Badger GJ, Mertz GJ, Corey L, Richman DD, Connor JD et al (1984) Treatment of recurrent genital herpes infections with oral aciclovir: a controlled trial. JAMA 251:2103–2107PubMedCrossRefGoogle Scholar
  13. 13.
    Kinghom G et al (1995) Episodic treatment for genital herpes. J Eur Acad Dermatol Venereol 5:S162CrossRefGoogle Scholar
  14. 14.
    Patel R, Bodsworth NJ, Wooley P et al (1997) Valaciclovir for the suppression of recurrent genital HSV infection: a placebo controlled study of once-daily therapy. Genitourin Med 73:105–109PubMedGoogle Scholar
  15. 15.
    Reitano M, Tyring S, Lang W, et al (1998) Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. J Infect Dis 178:603–610PubMedCrossRefGoogle Scholar
  16. 16.
    Whitley R (2006) New approaches to the therapy of HSV infections. Herpes 13:2Google Scholar
  17. 17.
    Aoki FY, Tyring S, Diaz Mitoma F, Gross G, Gao J, Hamed K (2006) Single-day patient initiated famciclovir therapy for recurrent genital herpes: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis 42:8–13PubMedCrossRefGoogle Scholar
  18. 18.
    Corey L, Wald A, Patel R et al (2004) Reduction in the transmission of genital herpes with suppressive valaciclovir. N Engl J Med 350:11–20PubMedCrossRefGoogle Scholar
  19. 19.
    Green J, Kocsis A (1997) Psychological factors in recurrent GH. Genitourin Med 73(4):253–258PubMedGoogle Scholar
  20. 20.
    Green J (2004) Psychosocial issues in GH management. Herpes 11(3):60–62PubMedGoogle Scholar
  21. 21.
    Conant MA, Shacker TW, Murphy RL (2002) International valaciclovir HSV study group. Valaciclovir versus Aciclovir for herpes simplex virus infection in HIV-infected individuals: two randomized trials. Int J STD AIDS 13:12–21PubMedCrossRefGoogle Scholar
  22. 22.
    Maier JA, Bergman A, Ross MG (1986) Acquired immuno-deficiency syndrome manifested by chronic primary genital herpes. Am J Obstet Gynecol 155:756–758PubMedGoogle Scholar
  23. 23.
    Englund JA, Zimmerman ME, Swierkosz EM et al (1990) Herpes simplex virus resistant to aciclovir: a study in a tertiary care center. Ann Intern Med 112:416–422PubMedGoogle Scholar
  24. 24.
    Foley E, Patel R (2004) Treatment of genital herpes infections in HIV-infected patients. J HIV Ther 9:14–18PubMedGoogle Scholar
  25. 25.
    Stanberry L, Cunningham A, Mertz G, Mindel A, Peters B, Reitano M, Sacks S, Wald A, Wassilew S, Woolley P (1999) New developments in the epidemiology, natural history and management of genital herpes. Antiviral Res 42(1):1–14PubMedCrossRefGoogle Scholar
  26. 26.
    Sacks SL, Griffiths PD, Corey L, Cohen C, Cunningham A, Dusheiko GM, Self S, Spruance S, Stanberry L, Wald A, Whitely RJ (2004) HSV-2 transmission. Antiviral Res 63(Suppl 1):S27–S35PubMedCrossRefGoogle Scholar
  27. 27.
    Brookes JL, Haywood S, Green J (1993) Adjustment to psychological and social sequelae of recurrent genital herpes simplex infection. Genitourin Med 69(5):384–387PubMedGoogle Scholar
  28. 28.
    Wald A, Andrea GM, Langenberg A, Krantz E, Douglas J, Handsfield H, DiCarlo R, Adimora A, Izu A, Morrow R, Corey L (2005) The relationship between condom use and HSV acquisition. Ann Inter Med 143:707–713Google Scholar
  29. 29.
    Wald A, Andria GM, Link K, Izu AE, Ashley R, Warren T, Tyring S, Douglas JM, Corey L (2001) Effect of condoms on reducing the transmission of HSV-2 from men to women. JAMA 285:24CrossRefGoogle Scholar
  30. 30.
    Starpharma Holdings (2006) LUX Executive Summit. Cambridge, MA, 16 Oct 2006,
  31. 31.
    Corey L, Andria GM, Langenberg A, Ashley R, Sekulovich RE, Izu AE, Douglas JM, Handsfield H, Warren T, Marr L, Tyring S, DiCarlo R, Adimora A, Leone P, Dekker C, Burke RL, Leong WP, Straus SE (1999) Recombinant glycoprotein vaccine for the prevention of genital HSV-2 infection. JAMA 28:4Google Scholar
  32. 32.
    Garnett GP, Dubin G, Slaoui M, Darcis T (2004) The potential epidemiological impact of a genital herpes vaccine for women. Sex Transm Infect 80:24–29PubMedCrossRefGoogle Scholar
  33. 33.
    Kleymann G, Fischer R, Betz UA, Hendrix M, Schneider U, Handke G, Eckenberg P, Hewlett G, Pevzner V, Baumeister J, Weber O, Henninger K, Keldenich J, Jensen A, Kolb J, Bach U, Popp A, Maben J, Frappa I, Haebich D, Lockhoff O, Rubsamen-Waigmann H (2002) New helicase–primase inhibitors as drug candidates for the treatment of herpes simplex disease. Nat Med 8:327–328CrossRefGoogle Scholar

Copyright information

© European Board and College of Obstetrics and Gynaecology 2006

Authors and Affiliations

  1. 1.Department of Genito-Urinary/HIV MedicineSouthampton University Hospitals NHS TrustSouthamptonUK

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