Herpesvirus.

Abstract

Herpesvirus (HSV) infection of the genital tract is a sexually transmitted disease that is increasing at an epidemic rate. 2 types of virus, Type 1 (HSV-1) and Type 2 (HSV-2) have been identified, of which HSV-2 is the major cause of genital and neonatal infection. Type 2 herpes infections may be the 2nd most common venereal disease in the US. More than 60% of the adult US population has antibodies to HSV, and socioeconomic factors have been found to influence the incidence of HSV infection. The precise incidence of genital herpes in the US is not known, but in 1979 there were 29.2/100,000 consultations for genital herpes, compared to 3.4/100,000 in 1966. As many as 20 million people have herpes, and there are 5 million new cases/year. Genital herpes occurs more frequently in a sexually active population. Clinical manifestations depend on the immune status of the individual and may be 1st episode primary genital herpes, 1st episode nonprimary genital herpes, or recurrent disease. 85% of primary 1st episode genital herpes are caused by HSV-2, the attack rate for susceptible sexual contacts from individuals with active genital lesions is approximately 75%, and the incubation period averages 6 days. 1st episode primary disease may produce severe localized symptoms as well as systemic symptoms. Complete resolution of lesions takes up to 6 weeks, and symptoms persist for an average of 13.8 days. 1st episode nonprimary genital herpes and recurrent disease have similar clinical courses, with ususally mild local symptoms lasting on average 6.9 days, no systemic symptoms, 1-3 lesions, complete resolution of lesions in 8 days, short duration of viral shedding, and presence of preexisting HSV antibodies. Possible complications of genital herpes infections include urethral and bladder infections and secondary bacterial skin infections, inflammatory radiculomyelitis, transverse myelitis, and aseptic meningitis. Humoral and cell-mediated immune responses are important. The majority of infections are diagnosed clinically. Viral culture is the most reliable laboratory technique. Other venereal diseases commonly coexist with genital herpes. To date there is no effective topical therapy for recurrent genital herpes. Cesarean section has been recommended to avoid infecting infants of infected mothers during delivery. Psychological and emotional problems caused by fears of infecting a sexual partner and increased risk of genital cancer in women are among longterm sequelae of genital herpes.