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Genital herpes simplex virus infections.

Genital HSV infection is an important sexually transmitted disease that is becoming more common. The primary infection typically is associated with systemic signs and symptoms and painful genital lesions, with a high rate of complications. Recurrences are much milder, with less frequent complications. Although many rapid diagnostic tests for genital herpes are now available, none is as sensitive or reliable as tissue culture. Dilemmas still exist regarding the best management strategy for the expectant mother at risk for transmitting HSV to the neonate, in part because of limitations in current diagnostic techniques. Although current treatment regimens with acyclovir can effectively control most symptoms and improve healing of lesions, they appear to have no effect on decreasing the frequency of subsequent recurrences. Short-term chronic suppression with acyclovir is effective in preventing symptomatic recurrences and appears to be relatively free of toxicity, but long-term studies are only now in progress. Asymptomatic viral shedding associated with either primary or recurrent infections and its contribution to sexual transmission of the disease are just now being fully appreciated, and the effect of therapy on subsequent transmission of disease remains to be determined. HSV genital infection in the immunocompromised host can produce a more severe and prolonged illness than in the normal host, but reactivation of the infection can be prevented with acyclovir suppression. Further research is needed on many aspects of the host-HSV interaction, especially regarding the factors involved in recurrences and the importance of the host's immune response to the manifestations of disease.