Antiviral therapy is effective but should be used with safer sex practices and counselling

Seven years ago, an editorial published in this journal called for studies to clarify the role of antiviral treatment in preventing the transmission of genital herpes.1 In the intervening years, seroprevalence studies in the United States have shown that the rate of infection with herpes simplex virus type 2 (HSV-2) has risen to 22%,2 whereas in Europe, rates between 4% and 44% have been reported.3 Support for an association between HSV-2 and HIV acquisition and transmission has increased, and anxiety about infecting their sexual partner is still among the top three concerns of people with genital herpes.4^–6 We know that antiviral treatment reduces symptomatic and asymptomatic shedding of HSV from genital mucosa,7^–9 but until now we have not known whether this would translate into a real, clinically important reduction in the transmission of genital herpes to an uninfected partner.

A recently published study was undertaken in 1484 heterosexual, immunocompetent couples to determine if daily valaciclovir could reduce the sexual transmission of genital herpes.10 One partner of each couple had clinically diagnosed genital HSV-2 infection, and the other …