Genital herpes--when and how to treat.

The link between genital ulcers and transmission of the human immunodeficiency virus highlights the need of prevention and treatment of genital herpes. Although a diversity of specific and unspecific drugs have been tested on effects toward herpes simplex virus types 1 and 2, only one antiviral drug, acyclovir, have proven safe and efficacious on some aspects of the disease. The drug has a marked effect on first episodes of herpes genitalis, but the effect on recurrences are less pronounced because viral replication is of shorter duration. Selection of patients for antiviral treatment involves considerations of immune status, the risk of neonatal transmission for pregnant women, and the severity of local and systemic symptoms, incidence of prodromal symptoms, and most importantly, recurrence rates, because this signals the psychological impact of the disease. The main goals of any herpes treatment--to eradicate latent infection in primary as well as recurrent disease--are not achieved by any known antiviral or immunomodulatory drug.