Genital Herpes: Treatment Guidelines.

Genital herpes, usually caused by herpes simplex virus type 2 (HSV-2), is the most common cause of genital ulceration. The primary episode of genital herpes is generally the most painful. Subsequent recurrences are generally milder and localized. Diagnosis is made clinically, but should be confirmed by culture or serology. Management includes antiviral drug therapy--acyclovir, valacyclovir, or famciclovir--as well as analgesics. In addition, patient counseling and education are vital. Antiviral treatment decreases the severity and duration of primary genital herpes and of recurrences, and it may be used as a continuous suppressive therapy to decrease the incidence of recurrence. Pregnant women who have a history of genital herpes or recent primary infection should deliver by cesarean section in the presence of genital lesions at labor or primary HSV infection at any time during the third trimester to prevent transmission to the neonate. Part 1, "Genital Herpes: Recognizing the Problem," addresses the problems involved in diagnosing the infection and quantifying the epidemic.