[Sexually transmitted diseases by herpes simplex, wart, hepatitis B, and human immunodeficiency virus]

Sexually transmissible diseases (STD), caused by viruses are by far the most important ones, even though German legislation has ignored them up to now as STD. Anogenital herpes is easily diagnosed by means of monoclonal antibodies. This makes therapy available with acyclovir without delay in atypical cases or for example in persons with immunodeficiency. The therapy regimen usually is 5 x 200-400 mg/day. Recurrent herpes in high frequency and with severe pain may be successfully suppressed by 2-5 x 200 mg/day of acyclovir orally without serious side effects. This will not eliminate herpes viruses. Anogenital warts may look very different and occasionally cannot be detected before local application of 3% acetic acid. Histology is diagnostic. There are different strains causing diseases in men. Therapy of choice is destroying infected cells by CO2-laser coagulation. The incidence of hepatitis B in developed countries is decreasing slowly within the past years, this may partly be due to vaccines, that are available since the early eighties, producing immunity in about 95%. Treatment of chronic hepatitis with interferons seems to be beneficial. Infections with the human immunodeficiency virus (HIV) and their end stage disease AIDS are a growing problem all over the world. Interventions are possible with different nucleoside analogs, e. g. zidovudine (AZT), dideoxycytidine (DDC), dideoxyinosine (DDI). Up to now there is no agreement on when to start with one of the drugs and if or when to switch to combination therapy. Hopefully this may stabilize immunologic parameters and hold disease progression to some time.