Public Health Strategies to Prevent Genital Herpes: Where Do We Stand?

At least 25% of the United States population has overt or subclinical genital herpes simplex virus (HSV) infection, and herpes probably is the sexually transmitted disease of greatest concern to sexually active persons, aside from AIDS. In addition to its direct clinical and psychosexual complications, genital herpes is an important determinant of sexual transmission of HIV. Genital herpes is usually transmitted by persons with subclinical infection, whether entirely asymptomatic or with unrecognized symptoms. Although the composition and efficacy of a national genital herpes prevention program are in debate, clinicians should adopt a public health perspective in managing patients to help prevent transmission. Specific approaches include accurate diagnosis of genital ulcer disease by routine use of virologic tests for HSV; use of type-specific serologic tests to diagnose subclinical HSV infection in patients' sex partners and others at high risk; counseling patients to recognize symptoms and defer sex with uninfected partners when symptomatic; and serologic testing and counseling of pregnant women and their partners to prevent neonatal herpes. Antiviral chemotherapy may be effective in preventing herpes-related cesarean sections, and its efficacy in preventing sexual transmission of HSV is under study.