Herpes genitalis

How suitable are available pharmaceuticals for the treatment of sexually transmitted diseases? (2) Conditions presenting as sores or tumours

The pharmaceutical industry is not supplying the penicillin preparations that are required for the treatment of syphilis. For those in whom penicillin hypersensitivity is suspected there is a need for a safe injectable alternative that is effective if given once daily or, preferably, at two- or three-day intervals. Existing treatments for chancroid, lymphogranuloma venereum, and granuloma inguinale are described, but even collectively there are few cases and treatments for other sexually transmitted diseases merit priority. Treatments for scabies and pediculosis pubis, although not perfect, are reasonable. There is a need for better local treatment for condylomata acuminata and systemic immunological methods, including those that increase cell-mediated immunity, deserve attention. The same is true for molluscum contagiosum. There is an urgent need for an effective, safe treatment of herpes genitalis that is able to eradicate the virus from the host. If it is proved that the herpes virus is responsible for carcinoma of the cervix this could then be the most serious sexually transmitted disease as in many countries such carcinomas are responsible for approximate seven times more deaths in women than is syphilis in men and women together. The limitations of prophylactic methods in preventing all possibility of infection with one or more of the sexually transmitted diseases are discussed.

Genital infection with type 2 herpes simplex virus. A common venereal disease

Current evidence leaves little doubt that genital herpes is primarily a venereal disease. Like gonorrhea, it is frequently subclinical or asymptomatic. A high rate of infection is found among patients attending venereal disease clinics and among persons of low socioeconomic status. The infection (primary or recurrent) is generally self-limiting, but in a pregnant woman it poses a significant risk to the fetus. It also has been linked to an increased risk of cervical cancer. The Papanicolaou smear is a useful tool for early detection. Effective antiviral therapy for genital herpes is unavailable. Photodynamic inactivation appears promising in recurrent herpes but may be hazardous; malignant transformation of infected cells subjected to this process has been demonstrated in vitro.