NEW CDC GUIDELINES STRENGTHEN HERPES TESTING, PATIENT EDUCATION, AND TREATMENT PROTOCOLS

By Curtis Phinney, Sc.MPH

In spring of 2002, the Centers for Disease Control and Prevention revised their guidelines for diagnosing and treating sexually transmitted diseases. The new guidelines describe more aggressive diagnostic and treatment protocols for many STDs, including herpes simplex virus (HSV). They offer healthcare providers current information to effectively address new and recurrent cases of herpes.

HSV is a common, and usually mild, recurrent skin condition. In what is known as oral herpes, HSV can cause cold sores," or "fever blisters." It can cause similar symptoms in the genital region, known as genital herpes. There are two known types of herpes simplex virus: type I (HSV 1) and type 2 (HSV-2).

Up to 30% of first-episode genital herpes cases are caused by HSV-1; individuals who are infected with this strain are less likely to experience recurring symptoms than those with HSV-2.

The CDC states at least 50 million people in the U.S. have genital herpes infection. Of these, the majority is infected with HSV-2 and most have not been diagnosed. Most genital herpes infections are transmitted by people who do not know they have herpes, or who do not have recognized symptoms at the time of transmission.

The new CDC guidelines emphasize three new focus areas in the treatment of genital herpes infections. First, type-specific testing should be used to improve the sensitivity and accuracy of diagnosis at first presentation. Second, antiviral drugs are the mainstay of effective treatment due to their well established safety and efficacy profiles. And finally, education and counseling are an essential component of an effective care regimen, enabling the patient to monitor and recognize his or her own symptoms and initiate antiviral treatment accordingly.

Laboratory Testing

it can be difficult for clinicians to determine if a patient has herpes if there are no blisters or ulcerative lesions present to aid in diagnosis. Since visual evidence is often unavailable to the clinician at first presentation, and since the type of FISV infection can influence the frequency with which symptoms may recur, the new CDC guidelines recommend confirming a diagnosis of herpes with laboratory testing. In addition, they state that both "cell culture" and "type -specific" tests for HSV should be available to health care practitioners who treat STD infections.

Antiviral Therapy

The new guidelines recognize that oral antiviral drugs offer clinical benefits to most patients who experience symptoms of genital herpes. CDC now recommends that clinicians provide antiviral therapy to most patients who appear to have first-episode genital herpes, and to see that patients have a supply of drug or a prescription on hand. For patients who suffer from frequent symptoms, CDC states that daily (suppressive) antiviral therapy reduces the frequency of recurrences by 70% - 80%. The safety and efficacy of these drugs is now well established. CDC recommends re-evaluating suppressive therapy once a year.

Patient Education and Counseling

The new guidelines describe patient education and support as "critical" to successful management of the condition. Patients with herpes need support and resources to help them effectively deal with infection, and prevent transmission to others. To view the new CDC guidelines, see: http://www.cdc.gov/STD/treatment/22002TG.htm#GenitalHerpes Patient education resources may be found at: http://www.ashastd.org/. Curtis Phinney can be contacted at spinney@erols.com

"THE NEW GUIDELINES DESCRIBE PATIENT EDUCATION AND SUPPORT AS CRITICAL TO SUCCESSFUL MANAGEMENT OF THE CONDITION."