A 28-year-old woman comes to the office for consultation. The patient has a history of recurrent genital herpes simplex virus (HSV) type 2 infections but has no symptoms at present. She has 3 or 4 symptomatic episodes a year. The patient has no other sexually transmitted infections or medical problems and takes no medications. She has a new male sexual partner who is HSV-seronegative.
Which of the following is the most effective strategy for decreasing this patient's risk of transmitting HSV to her partner?

Question

A 28-year-old woman comes to the office for consultation.  The patient has a history of recurrent genital herpes simplex virus (HSV) type 2 infections but has no symptoms at present.  She has 3 or 4 symptomatic episodes a year.  The patient has no other sexually transmitted infections or medical problems and takes no medications.  She has a new male sexual partner who is HSV-seronegative.
Which of the following is the most effective strategy for decreasing this patient's risk of transmitting HSV to her partner?

Quizplus · Accepted Answer

11ec193a_9851_11ff_853d_059ff9328c0b_MD0002_00 Recurrent herpes simplex virus (HSV) infection is common, particularly in patients with HSV-2. Partner transmission can occur in HSV-discordant couples due to asymptomatic viral shedding and symptomatic shedding during the prodromal period and active outbreaks. Multiple prevention strategies are available for discordant couples and have varying degrees of effectiveness. Patients with a history of HSV that was not confirmed by diagnostic testing (eg, viral culture) require serologic testing to determine infection status and type. It is also recommended that their sexual partners undergo evaluation to determine susceptibility. In immunocompetent heterosexual HSV-discordant couples, daily suppressive therapy (eg, valacyclovir) is the most effective strategy for reducing HSV transmission as it reduces asymptomatic viral shedding, decreases the number of outbreaks, and shortens outbreak duration. (Choice A) Patients can transmit HSV while asymptomatic (ie, viral shedding); therefore, abstinence limited to 2 weeks after an active outbreak is not the most effective method of transmission prevention. (Choice C) Meta-analysis has shown that male circumcision does not reduce HSV-2 transmission. (Choice D) Consistent condom use significantly reduces HSV male-to-female transmission. However, studies have shown a nonsignificant reduction of female-to-male transmission; therefore, condom use is not the most effective strategy in this patient. (Choice E) Medication taken during outbreaks may shorten the duration of symptoms. However, episodic treatment does not prevent HSV transmission due to viral shedding during the prodromal period. Educational objective: Herpes simplex virus transmission can occur with asymptomatic viral shedding and during prodromal phases and active lesions. The most effective strategy for reducing transmission is daily suppressive therapy. __________ References: Once-daily valacyclovir to reduce the risk of transmission of genital herpes. (http://www.ncbi.nlm.nih.gov/pubmed/14702423) Prevention of herpes simplex virus type 2 transmission with antiviral therapy. (http://www.ncbi.nlm.nih.gov/pubmed/15319087)

A 28-Year-Old Woman Comes to the Office for Consultation