Diagnosis, Treatment, and Prevention of Genital Herpes
Aug 14, 2024
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Christine Johnston, MD, an expert in herpes infections from the University of Washington, and Preeti Malani, MD, MSJ, JAMA Deputy Editor, delve into the complexities of genital herpes. They discuss the prevalence and transmission risks associated with HSV-1 and HSV-2. Key topics include the importance of accurate diagnosis, effective treatment options, and the significant stigma that impacts patients' lives. They emphasize the need for improved awareness and understanding to enhance patient care and outcomes.
Genital herpes, caused by HSV-1 and HSV-2, remains asymptomatic in many cases, highlighting the infection's stealthy nature and prevalence.
Effective treatment options like antiviral medications exist, yet suppressive therapy is often underutilized due to patient unawareness and stigma around the condition.
Deep dives
Understanding Genital Herpes Infections
Genital herpes, primarily caused by herpes simplex virus (HSV), has seen a shift in the understanding of its types and prevalence. While HSV1 was traditionally linked to oral infections and HSV2 to genital infections, it is now recognized that genital HSV1 is also a significant cause of genital herpes, affecting millions in the US. In 2018, approximately 18.6 million people were estimated to be living with genital HSV2 infection, with many more carrying HSV1. Interestingly, a majority of those infected remain asymptomatic, often unaware of their condition, which highlights the commonality and stealthy nature of this infection.
Diagnosis and Challenges in Identifying HSV
Diagnosing genital herpes involves understanding symptoms and utilizing appropriate testing methods. A clinical diagnosis is not recommended for asymptomatic individuals, yet serological tests are advised for those with partners diagnosed with the infection or displaying symptoms. Swabbing during an active outbreak is crucial for viral identification, as it enables differentiation between HSV1 and HSV2, both of which have different recurrence patterns. However, serologic tests can present challenges due to limitations in sensitivity and specificity, making it difficult to determine the exact nature of the infection, stressing the need for careful interpretation by both patients and clinicians.
Treatment Options and Managing Stigma
Antiviral medications such as acyclovir, valacyclovir, and famciclovir are the primary treatments for genital herpes, focusing on both suppression and episodic therapy. Suppressive therapy, which reduces the likelihood of outbreaks and transmission, is often underutilized as many patients are unaware of this option. Preventive measures, including condom use, can reduce transmission risk, but these methods are not foolproof, especially during symptomatic outbreaks. Furthermore, it's essential for healthcare providers to address the stigma associated with genital herpes, providing accurate information to alleviate patients' concerns and helping them manage their sexual health more confidently.
Genital herpes is a common sexually transmitted infection that is caused by HSV-1 or HSV-2 and may result in ulcers, neonatal herpes infection, and increased risk of HIV acquisition. Author Christine Johnston, MD, University of Washington, discusses herpes infection and more with JAMA Deputy Editor Preeti Malani, MD, MSJ. Related Content: