Herpes genitalis without frontiers: from clinical aspects to viral identification

Genital herpes simplex virus infection is a recurrent, lifelong disease with no cure. The strongest predictor for infection is a person's number of lifetime sex partners. HSV-2 is the commonest responsible, although infections caused by HSV-1 are rapidly increasing, particularly in adolescents, women and men who have sex with men. The natural history includes first-episode of mucocutaneous infection, establishment of latency in the dorsal root ganglion, and subsequent reactivation. Most infections are transmitted via asymptomatic viral shedding. Atypical manifestations are common. Genital HSV-2 recurs six times more frequently than type 1. Laboratory confirmation of the clinical diagnosis is recommended in all patients in order to guide a correct counselling and management. Real-time PCR and viral culture represent the gold standard for diagnosis. Serologic testing can be useful in persons with a questionable history. Counselling patients about the risk of transmission is crucial and helps prevent the spread of disease and neonatal complications.