Genital Herpes: Treatment Guidelines

, Withington Hospital and University of Manchester


Medscape General Medicine. 1997;1(2) 

In This Article

Abstract and Introduction


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.


In most cases of first-episode HSV infection, a diagnosis can be confidently made on the basis of clinical signs, and treatment should not be delayed while awaiting confirmation of the pathogen. Early counseling at the time of diagnosis may help to address some of the patient's fears, but in most cases, further support after resolution of the first episode is necessary.

Many patients are anxious about the potential long-term consequences associated with the virus because of the wide coverage by the media. Women in particular may be worried about the risks of infertility, cervical cancer, transmission to sexual partners, and perinatal transmission.