Herpes simplex virus-2 infection. An emerging disease?

Genital herpes infections continue to increase in the world. As outlined previously, several factors play a role in the continued transmission of genital herpes worldwide. Reducing the medical consequences of HSV-2 infection will not be easy. It is also sobering to realize that widespread penetration of HSV-2 into the population had preceded the spread of sexually acquired HIV in most countries. The biological rationale for a connection between HIV and HSV continues to be strengthened. Currently, a specific program to decrease the transmission of genital herpes does not exist. Recent studies with antiviral agents indicate the potential of these compounds to reduce shedding in HIV-negative and in HIV-positive persons and potentially may be useful in preventing some aspects of HSV transmission. Advances in laboratory techniques to assist in the diagnosis of genital herpes infections have added to our knowledge of the natural history and epidemiology of infection. Because of imperfect laboratory tests, negative results do not always indicate lack of infection; this has important public health implications. Large numbers of unrecognized symptomatic cases and frequent asymptomatic shedding are the likely source of continued genital HSV-2 transmission. Solutions for reducing the transmission of genital herpes range from simple, such as counseling patients regarding symptoms and signs of genital herpes and the frequency of subclinical shedding, to complex and expensive, such as screening high risk populations (e.g., STD clinic attendees) for HSV-2 infection. Chronic antiviral therapy may be indicated in HSV-2 seropositive persons without monogamous relationships as they are at risk to transmit HSV to multiple persons. The authors' aim in this review is to provoke discussion of such a control program and to raise the consciousness of the feasibility of instituting control measures for selected populations. We hope to elicit pilot programs designed to reduce the morbidity of this old but re-emerging infectious disease.