Review paper
The clinic and epidemiology of genital herpes

The objective of this paper was to describe the clinic and epidemiology of genital herpes. Genital herpes is among the most common sexually transmitted diseases worldwide. Historically HSV-2 has been associated with genital infection, whereas HSV-1 has been associated with oral mucocutaneous disease. However, the proportion of genital HSV-1 has increased in many countries. Symptoms of primary HSV-1 and HSV-2 genital infections are similar; however, recurrence of the infection is less frequent after HSV-1 – related genital infection. Genital HSV infection encompasses a broad spectrum of clinical conditions, from classical painful vesicular eruption to truly asymptomatic infections. Clinically atypical presentations include either unusual sites or atypical morphological forms. Genital HSV can be one of the possible aetiological agents of nongonococcal urethritis. Concomitant HSV-1 infection appeared to protect against symptom expression in subjects coinfected with HSV-2. HSV infection is transmitted by close body contact and a childbearing woman may transmit the virus to the neonate during birth, resulting in life-threatening herpes neonatorum generalisatus. Genital herpes can cause devastating disease among neonates and immunosuppressed people and facilitates transmission of HIV. Recent studies suggest that HSV-2 infection may elevate viral load during HIV-1 infection and hence lead to accelerated disease progression. HSV-2 infection increases the risk of HIV-1 acquisition. HIV immune suppression increases the rate of HSV-2 reactivation, and HIV acquisition risk is highest among those with a recent incident of HSV-2 infection. In primary care, the diagnosis of genital herpes is important both for the patient and for the patient’s sex partners. Appropriate use of antiviral medications can reduce the severity of established outbreaks or prevent future outbreaks and therefore reduce transmission of virus infection from infected patients to their uninfected partners.