Herpes simplex virus type 2 (HSV-2) causes most genital herpes infections, although HSV-1 causes 50% of first cases (CDC, 2006). An estimated 20% of those older than 12 years have it, and infection is often asymptomatic (USP-STF, 2005). Symptoms, if present, may present as multiple,
small, painful ulcers or vesicles (Fig. 40-14). Causative virus is prognostically important, so confirmatory testing is recommended. Polymerase chain reaction testing is sensitive, whereas a Tzanck test is not (CDC, 2006). Serologic tests for herpes IgG are available but do not differentiate acute from remote infection. The U.S. Preventive Services Task Force (USPSTF, 2005) recommends against routine screening for HSV in asymptomatic adults because there is no evidence that this decreases disease transmission or reduces morbidity. Antiviral medications can treat acute outbreaks and be used as prophylaxis to prevent recurrent outbreaks.
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