[Genital herpes with special emphasis on perinatal herpes simplex virus infection]

The incidence of genital herpes is increasing worldwide and at present herpes simplex virus type 2 is the most common cause of genital ulceration all over the world.

The International Herpes Management Forum (IHMF) was established in 1993, suggesting a new classification of genital herpes: primary genital herpes, non-primary genital herpes, recurrent genital herpes, first episode genital herpes, atypical genital herpes and asymptomatic HSV (herpes simplex virus) infection.

Clinical diagnosis of genital herpes should be confirmed by laboratory techniques, whereas a positive HSV culture is the best test for confirming the clinical diagnosis. Serological testing, including Western blot assay, is not the method of choice for diagnosis genital herpes.

Management of patients with genital herpes must include various antiviral drugs (acyclovir, valacyclovir, famiclovir), but also must take into consideration the patients' clinical and emotional issues. Patients with few recurrences are best managed with episodic antiviral therapy, but those with more frequent recurrences may find a long term suppressive therapy more beneficial. Herpes simplex virus is acquired during labor in about 90% of neonatal herpes virus cases with direct contact with infected maternal genital secretions, in 5% of cases in utero (ascending infection or transplacentary) and in another 5% of cases HSV is acquired post partum. Herpes simplex virus infection includes skin infection, eye and mouth manifestations, CNS diseases and disseminated disease with multiorgan involvement.

In order to reduce the risk of HSV transmission to the infant IHMF has suggested management of pregnant women with primary genital herpes: delivery by Caesarean section between 34th week and term. Acyclovir treatment may reduce the viral load at delivery, but before this can generally be recommended, more data are still required.