Abstract

PIP: This paper offers a comprehensive review of the literature on the epidemiology of genital herpes simplex virus infection. Topics covered include its microbiology, immunology, incidence, prevalence, pathogenesis and clinical course, diagnosis, treatment, transmission, prevention, and effect on pregnancy outcome. The prevalence of genital herpes is estimated at 20 million persons in the US, about 25% of whom are symptomatic. Determination of the actual incidence and prevalence of genital herpes requires the availability of methods able to distinguish precisely between type 1 and type 2 antibody. Indirect evidence suggests an increasing incidence of the disease over the past 15 years. Asymptomatic infected persons may shed virus in the absence of lesions and thus transmit genital herpes to their sexual partners. Of particular concern is vertical transmission of virus from the maternal genital tract to newborns. In the majority of documented cases of neonatal herpes, the mothers were asymptomatic at the time of delivery. Because of the severe morbidity and mortality associated with neonatal herpes infection, studies are urgently needed to identify risk factors for vertical transmission and to design and test appropriate preventive intervention strategies. At present, treatment of genital herpes is limited to palliative therapy. No known antiviral agent either prevents or eliminates viral latency, although vaccines are under development for primary prevention. The role of contraceptive practice in the prevention of genital herpes infection is unclear. Although theoretically plausible, the efficacy of barrier methods in decreasing the risk of acquiring or transmitting infection has not yet been demonstrated. Virus may be present in areas not covered by condoms. Use of a spermicidal cream or jelly with a diaphragm may reduce the risk of virus infection and transmissions, but, again, this method cannot protect from virus transmission to or from the external genitalia.