Limiting the spread of genital herpes.

In many western countries, successful control of bacterial sexually transmitted diseases (STDs) has contrasted with an increase in the prevalence of viral STDs. The continued increase in clinical and subclinical genital herpes infections is of particular concern because of the implications for the risk of coincident spread of human immunodeficiency virus infection. Advances in knowledge of the epidemiology and natural history of genital herpes must be the basis of renewed educational efforts targeted at the general public, healthcare professionals, as well as infected persons. Diagnostic techniques, such as polymerase chain reaction and type-specific serology, now allow increased detection of subclinical infection. However, infected persons must be assured of access to effective antiviral treatment and comprehensive holistic management if the clinical and epidemiological benefits of detection are to outweigh the psychological and psychosocial disadvantages of being infected with a stigmatized condition. Vaccines could offer the best prospect for both primary prophylaxis and immunotherapy of genital herpes, and may have the greatest impact in limiting the spread of this infection. Recent progress has been made in the development of effective and safe vaccines, and their successful introduction should be a major priority over the next decade.