Improving the care of patients with genital herpes

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Susan Drake, consultant genitourinary physician (s.m.drake@bham.ac.uk)a,
Stephen Taylor, clinical research fellowa,
David Brown, consultant medical virologistb,
Deenan Pillay, consultant medical virologistc

^a Department of Sexual Medicine, Heartlands Hospital, Birmingham B9 5SS
^b Central Public Health Laboratory, London NW9 5DF
^c Public Health Laboratory Service, Antiviral Susceptibility Reference Unit, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT

Correspondence to: S Drake

Clinical experience suggests that many doctors view genital herpes as an uncommon minor illness for which there is little effective treatment. Yet the converse is true. More than 28 000 cases of genital herpes were reported from clinics dealing with sexually transmitted diseases in England in 1998, and seroprevalence studies suggest that there are many more unrecognised infections. Patients often present having had frequent painful attacks of genital ulceration for many years, although effective antiviral drugs are available that dramatically reduce morbidity if used appropriately. In addition patients often believe that they are infectious only during symptomatic episodes, despite evidence that most transmission occurs from asymptomatic shedding of the virus.1 This poor understanding may result in unnecessary morbidity for patients and their partners and inhibits efforts to reduce the spread of genital herpes.

Summary points

Up to 50% of first episode genital herpes in the United Kingdom is attributable to herpes simplex type 1 virus, although recurrences are far more likely after infection with herpes simplex type 2 virus

Many patients and clinicians are unaware that oral sex is a common route of transmission of genital herpes infections

Transmission from asymptomatic individuals in monogamous relationships can occur after several years, causing severe psychological distress

The majority of patients with genital herpes simplex virus infections have symptoms and signs unrecognised by either themselves or their clinicians

Oral antiviral treatment should be given for primary or first episode genital herpes, and long term oral suppressive antiviral treatment is highly effective in reducing recurrences of symptoms in selected patients

Acquisition of a new herpes simplex virus type in the third trimester of pregnancy can have serious implications for the neonate and requires specialist intervention