Purpose of review: The aim of this review is to summarize recent developments in our understanding of the modifiable behavioural and biological factors contributing to the transmission of genital herpes simplex infection, and the limited data on the use of antiviral agents for reducing transmission risk in serodiscordant couples.
Recent findings: With the developing herpes simplex virus epidemic, the significance of biological and behavioural factors for the acquisition and transmission of genital herpes infection are increasingly recognized as important. Studies looking at the modification of behavioural factors indicate that knowledge of disease status, disease recognition and the promotion of condoms appears to modify transmission risk. However, these effects are disputed and their value is likely to be limited. In the absence of effective prophylactic vaccines, the reduction of clinical and subclinal herpes simplex virus shedding with the use of antiviral agents is an attractive option. A large study recently reported on the value of once daily valaciclovir for the prevention of transmission of genital herpes infection in serodiscordant couples. The study showed that continuous suppressive therapy not only controls symptomatic disease in the source partner, but reduces the likelihood of disease in the susceptible partner by between 48 and 75%. These findings will have a major impact on clinical practice. Questions remain, however, on whether these results can be extended to non-heterosexual populations and to drugs other then valaciclovir.