Mertz G J
Department of Medicine, University of New Mexico School of Medicine, Albuquerque.
Med Clin North Am. 1990 Nov;74(6):1433-54. doi: 10.1016/s0025-7125(16)30489-8.
There has been a dramatic increase in patient visits to physicians for evaluation and treatment of genital herpes infections. This has resulted in part from an increase in genital herpes infections, particularly severe, first-episode genital herpes infections in adults without prior HSV-1 infection. Virus culture remains the most sensitive and specific method for diagnosis, and use of viral cultures is encouraged. Type-specific antibody tests have been employed in studies documenting the role of asymptomatic shedding of HSV in transmission of genital infections, the role of genital HSV in transmission of HIV, the predominance of asymptomatic and unrecognized infections in those infected with HSV-2, and the presence of past asymptomatic or unrecognized acquisition of HSV-2 in 25% of persons presenting with first-episode genital herpes. Unfortunately, commercially available serologic tests do not reliably differentiate between antibody to HSV-1 and HSV-2. Recent studies suggest that the annual risk of transmission from a sexual partner with genital herpes is about 10% in heterosexual couples. Currently, promotion of "safe sex" is the only available approach for prevention of transmission. However, ongoing research is focused on the development of an effective vaccine. Acyclovir should be used routinely in persons with first-episode genital herpes, but careful evaluation is needed in persons with recurrent genital herpes to determine whether episodic or suppressive treatment is indicated. Acyclovir should also be used routinely for episodic or suppressive treatment of HSV infections in persons with AIDS. Additional antiviral agents are needed for more effective suppressive therapy and for treatment of ACV-resistant HSV infections in the immunocompromised host.
因生殖器疱疹感染前来就医评估和治疗的患者数量急剧增加。部分原因是生殖器疱疹感染有所增多，尤其是在未曾感染过HSV-1的成年人中出现的严重初发性生殖器疱疹感染。病毒培养仍然是诊断最敏感和特异的方法，因此鼓励使用病毒培养。型特异性抗体检测已用于多项研究，这些研究记录了HSV无症状排毒在生殖器感染传播中的作用、生殖器HSV在HIV传播中的作用、HSV-2感染者中无症状和未被识别感染的主导地位，以及在初发性生殖器疱疹患者中25%曾有无症状或未被识别的HSV-2感染。不幸的是，市售的血清学检测无法可靠地区分HSV-1和HSV-2抗体。最近的研究表明，在异性恋伴侣中，来自患有生殖器疱疹的性伴侣的年传播风险约为10%。目前，推广“安全性行为”是唯一可行的预防传播方法。然而，正在进行的研究主要集中在开发有效的疫苗。阿昔洛韦应常规用于初发性生殖器疱疹患者，但对于复发性生殖器疱疹患者，需要仔细评估以确定是否需要进行发作期或抑制性治疗。阿昔洛韦也应常规用于艾滋病患者HSV感染的发作期或抑制性治疗。需要更多的抗病毒药物用于更有效的抑制性治疗以及治疗免疫功能低下宿主中对阿昔洛韦耐药的HSV感染。
