Genital Herpes: Rapid Evidence Review

Genital herpes is a sexually transmitted infection caused by herpes simplex virus (HSV) type 1 or 2. It affects at least 500 million people worldwide and is a lifelong condition involving initial infection and periodic reactivation with variable viral shedding. There are no vaccinations for the prevention of HSV, and routine serologic screening is not recommended in asymptomatic individuals. Practices that prevent or reduce transmission include the use of suppressive antiviral therapy in serodiscordant partners, avoiding sexual contact during outbreaks, and use of condoms. A clinically apparent herpes outbreak is characterized by painful vesicles on the genitals, rectum, or perineum and may be accompanied by a flulike syndrome of fever, malaise, and lymphadenopathy. Diagnosis uses type-specific polymerase chain reaction, viral culture of active lesions, or type-specific serologic testing. Nucleoside analogue medications reduce viral shedding and are used to treat active outbreaks and prevent recurrences. Complications of genital herpes include encephalitis, meningitis, and urinary retention. During pregnancy, antiviral suppression is recommended starting at 36 weeks of gestation in patients with a known history of genital herpes. Elective cesarean delivery should be offered to patients with active lesions to reduce neonatal exposure to HSV.