Advertisement
JOGC

No. 207-Genital Herpes: Gynaecological Aspects

      Abstract

      Objective

      The purpose of this guideline is to provide recommendations to gynaecology health care providers on optimal management of genital herpes.

      Outcomes

      More effective prevention of complications and transmission of genital herpes.

      Evidence

      Medline was searched for articles published in French and English related to genital herpes and gynaecology. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed.

      Recommendations

      • 1.
        Up to 70% of all genital HSV-2 infections are transmitted during asymptomatic shedding; therefore, the use of condoms is recommended to lessen the likelihood of disease transmission (II-A).
      • 2.
        A laboratory-based diagnosis of genital herpes is essential for its effective management (II-A).
      • 3.
        Suppressive treatment is suggested for patients who have
        • at least 6 recurrences per year
        • significant complications, but fewer than 6 recurrences per year
        • their quality of life significantly affected
        • social and sexual dysfunction
        • to lower the risk of transmission to a sexual partner or fetus/neonate (II-B).
      • 4.
        The use of the anti-viral valacyclovir, coupled with condoms and safer sex counselling, is recommended for individuals with proven genital herpes (I-B).
      • 5.
        Routine or targeted HSV screening is not indicated (III-B).

      Key Words

      Abbreviations:

      HIV (human immunodeficiency virus), HSV (herpes simplex virus), NAAT (nucleic acid amplification techniques), PCR (polymerase chain reaction), STI (sexually transmitted infection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Money D.
        • Steben M.
        Management of Herpes simplex virus in pregnancy. SOGC Clinical Practice Guideline, 207.
        J Obstet Gynaecol Can. 2008; 30: 514-519
        • Woolf S.H.
        • Battista R.N.
        • Angerson G.M.
        • et al.
        • Canadian Task Force on Preventive Health Care
        New grades for recommendations from the Canadian Task Force on Preventive Health Care.
        CMAJ. 2003; 169: 207-208
        • Webb D.H.
        • Fife K.H.
        Genital herpes simplex virus infections.
        Infect Dis Clin North Am. 1987; 1: 97-122
        • Benedetti J.
        • Corey L.
        • Ashley R.
        Recurrence rates in genital herpes after symptomatic first-episode infection.
        Ann Intern Med. 1994; 121: 847
        • Steben M.
        • Sacks S.L.
        Genital herpes: the epidemiology and control of a common sexually transmitted disease.
        Can J Hum Sex. 1997; 6: 127-134
        • Patrick D.M.
        • Dawar M.
        • Krajden M.
        • et al.
        Antenatal seroprevalence of Herpes Simplex Virus Type 2 (HSV-2) in Canadian Women.
        Sex Transm Dis. 2001; 28: 424-428
        • Fleming D.T.
        • McQuillan G.M.
        • Johnson R.E.
        • et al.
        Herpes simplex virus type 2 in the United States, 1976 to 1994.
        N Engl J Med. 1997; 337: 1105-1111
        • Hitchcock P.J.
        • MacKay H.T.
        • Wasserheit J.N.
        Sexually transmitted diseases and adverse outcomes of pregnancy.
        ASM. 1999; : 248-249
        • Mertz G.J.
        • Benedetti J.
        • Ashley R.
        • et al.
        Risk factors for the sexual transmission of genital herpes.
        Ann Intern Med. 1992; 116: 197-202
        • Wald A.
        • Zeh J.
        • Selke S.
        • et al.
        Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons.
        N Engl J Med. 2000; 342: 844-850
        • Wald A.
        • Zeh J.
        • Selke S.
        • et al.
        Genital shedding of herpes simplex virus among men.
        J Infect Dis. 2002; : S34-S39
        • Schacker T.
        • Zeh J.
        • Hu H.L.
        • et al.
        Frequency of symptomatic and asymptomatic herpes simplex virus type 2 reactivations among human immunodeficiency virus-infected men.
        J Infect Dis. 1998; 178: 1616-1622
        • Brock B.V.
        • Selke S.
        • Benedetti J.
        • et al.
        Frequency of asymptomatic shedding of herpes simplex virus in women with genital herpes.
        JAMA. 1990; 263: 418-420
      1. Strategies for interrupting the transmission of genital HSV infection. International herpes management forum. Available at: http://www.ihmf.org/journal.asp. Accessed March 7, 2008.

        • Sacks S.L.
        Frequency and duration of patient-observed recurrent genital herpes simplex virus infection: characterization of the nonlesional prodrome.
        J Infect Dis. 1984; 150: 873-877
        • Steben M.
        Genital herpes simplex virus infection.
        Clin Obstet Gynecol. 2005; 4: 838-844
      2. Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections. 2006 edition. Available at: http://www.phac-aspc.gc.ca/std-mts/sti_2006/sti_intr02006_e.html. Accessed February 21, 2008.

        • Corey L
        • Wald A.
        • Patel R.
        • et al.
        Once-daily valacyclovir to reduce the risk of transmission of genital herpes.
        N Engl J Med. 2004; 350: 11-20
        • Stanberry L.R.
        • Spruance S.L.
        • Cunningham A.L.
        • et al.
        Glycoprotein- D-adjuvant vaccine to prevent genital herpes.
        N Engl J Med. 2002; 347: 1652-1661
        • Clarke P.
        The impact of a herpes diagnosis and the implications for patient counselling.
        in: Sacks S.L. Whitley R.J. Griffiths Clinical management of herpes viruses. IOS Press, Burke1995: 75-86
        • Fortenberry J.D.
        The effects of stigma on genital herpes care-seeking behaviours.
        Herpes. 2004; 11: 8-11