From the Guidelines
Genital Herpes Simplex Virus (HSV) symptoms include recurrent, self-limited genital ulcers. The treatment options for Genital Herpes Simplex Virus (HSV) are primarily focused on managing symptoms and preventing transmission to sexual partners.
Symptoms of Genital Herpes
- Recurrent, self-limited genital ulcers
- HSV-1 and HSV-2 are prevalent infections, with 47.8% and 12.1% of the United States population aged 14–49 years seropositive for HSV-1 and HSV-2, respectively, in 2015–2016 1
Treatment Options
- Episodic antiviral therapy: patients take short courses of antiviral therapy at the time of a genital herpes recurrence
- Suppressive antiviral therapy: patients take medications on a daily basis to prevent recurrences and shedding
- Medications used for treatment include acyclovir, famciclovir, and valacyclovir 1
- The same medication dosages and frequencies are recommended for genital HSV-1 infection as for genital HSV-2 infection
Management Approaches
- Prevention of symptoms/recurrences and improvement in quality of life
- Prevention of transmission to sexual partners 1
- Patient education on the natural history of infection to combat stigma associated with genital herpes
New Antivirals in Development
- Helicase-primase inhibitors have been studied in early-phase clinical trials but have not been evaluated in phase 3 studies and are not FDA-approved for treatment at this time 1
- Tenofovir preparations have been studied for prevention of genital shedding and recurrences among women with HSV-2 infection, but showed no difference in shedding or lesions 1
From the Research
Symptoms of Genital Herpes Simplex Virus (HSV)
- Primary infection typically is associated with systemic signs and symptoms and painful genital lesions, with a high rate of complications 2
- Recurrences are much milder, with less frequent complications 2
- A visible outbreak consists of single or clustered vesicles on the genitalia, perineum, buttocks, upper thighs, or perianal areas that ulcerate before resolving 3
- Symptoms of primary infection may include malaise, fever, or localized adenopathy 3
- Asymptomatic shedding of transmissible virus is common 3
Treatment Options for Genital Herpes Simplex Virus (HSV)
- Current therapies include episodic treatment and chronic suppressive therapy and are generally well tolerated and effective 4
- Treatment of primary and subsequent outbreaks with nucleoside analogues is well tolerated and reduces duration, severity, and frequency of recurrences 3
- Antiviral prophylaxis with acyclovir is recommended from 36 weeks of gestation until delivery in women with a history of genital herpes 3
- Short-term chronic suppression with acyclovir is effective in preventing symptomatic recurrences and appears to be relatively free of toxicity 2
- Although current treatment regimens with acyclovir can effectively control most symptoms and improve healing of lesions, they appear to have no effect on decreasing the frequency of subsequent recurrences 2
Complications and Transmission of Genital Herpes Simplex Virus (HSV)
- Genital herpes simplex virus infections are among the most prevalent sexually transmitted infections in the United States and continue to be a public health concern because of its recurrent nature and potential for complications 4
- HSV infection can lead to meningitis, encephalitis, and neonatal herpes as a result of vertical transmission 5
- HSV infection increases the rates of human immunodeficiency virus (HIV) infection and transmission 5, 3
- Patients with HSV-2 have a higher risk of acquiring human immunodeficiency virus (HIV) infection 3