Clinical Review

Genital herpes and its management

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39189.504306.55 (Published 17 May 2007) Cite this as: BMJ 2007;334:1048
  1. P Sen, consultant1,
  2. S E Barton, consultant and clinical director,2
  1. 1National Skin Centre, 1 Mandalay Road, Singapore 308205
  2. 2Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital Foundation NHS Trust, London SW10 9NH
  1. Correspondence to: S Barton simon.barton{at}chelwest.nhs.uk

    Introduction

    Genital herpes is an important public health disease and is the leading cause of genital ulcer disease worldwide. We present the latest evidence based guidelines from the British Association for Sexual Health and HIV (BASHH), the Centers for Disease Control and Prevention (CDC), and other expert committees to provide an up to date account of genital infection with herpes simplex virus (HSV), its clinical features and diagnosis, and a practical approach to management of affected patients. Treatment regimens have largely been based on evidence obtained from randomised controlled trials, while certain new diagnostic tests are limited by lower levels of evidence obtained only from descriptive or case studies.

    Summary points

    • Genital herpes is the leading cause of genital ulcer disease worldwide

    • Most patients with genital herpes have no symptoms and shed virus intermittently in the genital tract

    • Counselling of patients and their sexual partners is critical in the management of genital herpes

    • Caesarean section is recommended for all pregnant women presenting with a first episode of genital herpes after 34 weeks' gestation

    • Genital herpes caused by HSV-2 infection has been shown to double the risk of becoming infected with HIV through sexual transmission

    • Suppressive antiviral therapy for genital herpes should be routinely offered to people with both HSV and HIV

    Sources and selection criteria

    We searched PubMed (1966-2006) for relevant studies using keywords and text terms for genital herpes. We accessed the WHO and Health Protection Agency (United Kingdom) website to assess the disease burden of genital herpes and consulted guidelines on genital herpes from the British Association for Sexual Health and HIV (2001) and the Centers for Disease Control and Prevention (CDC, 2006). Additional data and references were obtained from International Union against Sexually Transmitted Infections (IUSTI) meetings, BASHH meetings, the International Herpes Management Forum (IHMF), the World STI/HIV congress, and a personal archive of …

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