Advising patients with genital herpes

Aciclovir reduces asymptomatic viral shedding, but effect on transmission is unclear

The traditional view of genital herpes is that it is a low prevalence sexually transmitted disease, principally caused by herpes simplex virus type 2.1 However, the new type specific antibody tests, which can accurately distinguish between antibodies to herpes simplex virus type 1 and type 2, have shown that infection with herpes simplex virus type 2 is not only common2 3 4 but often goes unrecognised–only about a third of those infected are diagnosed.3 5 Among patients in Britain presenting with a first episode of genital herpes, infection due to herpes simplex virus type 1 is common, accounting for 20-60% of cases.6 7 8

Genital herpes is often associated with considerable psychosexual morbidity, particularly around the time of initial diagnosis.9 A major concern for infected people is that they may infect their sexual partners.10 In the past, patients were reassured that this could happen only if they had sex during episodes of acute genital blistering and ulceration.11 12 Recent data from epidemiological, natural course, and antiviral studies suggest that this advice may be misleading. In one of the few prospective studies of transmission of genital herpes, …