Genital herpes can be caused by herpes simplex virus 2 (HSV-2) or, less
commonly, by herpes simplex virus 1 (HSV-1). With a seroprevalence of antibodies
to HSV-2 of 22% in the general population, genital herpes is 1 of the 3 most
prevalent sexually transmitted diseases (STDs) in the United States. A central
issue in the public health problem of genital herpes is the high proportion
of genital HSV infections that are unrecognized by both patients and clinicians.
Persons who are HSV-2 seropositive may be symptomatic but nevertheless fail
to recognize genital herpes; they serve as reservoirs for transmission. Physicians
and patients must be aware of the subclinical presentation of genital herpes
and the potential these patients have for transmitting HSV. Serious consequences
of HSV infection include neonatal herpes and increased risk of human immunodeficiency
virus transmission. Recommendations to physicians for prevention include using
type-specific tests for HSV when screening for other STDs and testing for
HSV when evaluating patients with genital ulcers. Researchers must evaluate
the performance of type-specific tests and strategies to prevent transmission.