Editorials

Advising patients with genital herpes

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7074.85 (Published 11 January 1997) Cite this as: BMJ 1997;314:85

Aciclovir reduces asymptomatic viral shedding, but effect on transmission is unclear

  1. Raj Patel, Senior lecturera,
  2. Frances M Cowan, Senior lecturerb,
  3. Simon E Barton, Clinical directorc
  1. a Department of Genitourinary Medicine, Southampton University Hospitals NHS Trust, Southampton SO14 0YG
  2. b Department of Sexually Transmitted Diseases, University College London Medical School, London WC1E 6AU
  3. c HIV/Genitourinary Medicine Clinical Directorate, Chelsea and Westminster Hospital, London SW10 9TN

    The traditional view of genital herpes is that it is a low prevalence sexually transmitted disease, principally caused by herpes simplex virus type 2.1 However, the new type specific antibody tests, which can accurately distinguish between antibodies to herpes simplex virus type 1 and type 2, have shown that infection with herpes simplex virus type 2 is not only common2 3 4 but often goes unrecognised–only about a third of those infected are diagnosed.3 5 Among patients in Britain presenting with a first episode of genital herpes, infection due to herpes simplex virus type 1 is common, accounting for 20-60% of cases.6 7 8

    Genital herpes is often associated with considerable psychosexual morbidity, particularly around the time of initial diagnosis.9 A major concern for infected people is that they may infect their sexual partners.10 In the past, patients were reassured that this could happen only if they had sex during episodes of acute genital blistering and ulceration.11 12 Recent data from epidemiological, natural course, and antiviral studies suggest that this advice may be misleading. In one of the few prospective studies of transmission of genital herpes, …

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