Elsevier

The Lancet

Volume 351, Supplement 3, June 1998, Pages S16-S18
The Lancet

Supplement
Genital herpes—how much of a public-health problem?

https://doi.org/10.1016/S0140-6736(98)90005-8Get rights and content

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Morbidity and mortality

Primary genital HSV infection can cause extensive genital and perigenital vesiculation and ulceration with severe genital pain and dysuria. Without antiviral treatment, the episode can last 3 or more weeks.6 Many patients, particularly those with genital HSV-2 infection, will have recurrent episodes. These are usually of shorter duration and lesser severity than the first episode but may occur frequently–some patients can have 12 or more episodes a year.6 Many individuals, particularly those

Antiviral treatment

Antiviral drugs have improved the outcome for patients with genital herpes. In first episode genital herpes, aciclovir, its prodrug valaciclovir, and famciclovir (a prodrug of penciclovir) have all been shown to decrease the duration of symptoms and viral shedding and to hasten the time of healing. These drugs seem to have similar efficacy. However, valaciclovir and famciclovir have better bioavailability and consequently a less frequent and more convenient dosing schedule.10, 11, 12 The

Epidemiology and type-specific serology

The introduction of HSV type-specific serological tests has revealed that HSV-2 infections are far more common than previously suspected. Several studies have been conducted that reveal a wide variation in HSV-2 seropositivity depending on the type of patients studied and the geographical location (panel).14, 15, 16, 17, 18, 19, 20, 21, 22, 23 All these studies have been done in selected groups or populations and provide limited information only about the prevalence of HSV-2 in communities.

Two

Public-health measures to control HSV-2

The possible clinical use of type-specific serology is creating considerable controversy for STD physicians worldwide. Some authorities are now recommending the widespread use of type-specific HSV serology as a public-health measure to control the epidemic,31 based on the increase in HSV-2 prevalence in the USA and the observation that many patients attending a UK STD clinic would like to have the test.32 Ashley and Corey31 suggest that an individual's knowledge of their HSV status will lead to

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