Herpes simplex virus (HSV) is the most common cause of anogenital ulceration worldwide. There are two distinct viruses: HSV-1 associated with oro-labial cold sores and genital infection and HSV-2 associated with genital infection. Infection is lifelong, and typically presents with painful anogenital ulceration, which may recur after periods of latency. Asymptomatic shedding is common and may lead to transmission to sexual partners. Antiviral suppression with aciclovir, valaciclovir, or famciclovir is useful to treat initial painful episodes or troublesome recurrent infection. Suppressive antiviral therapy, condoms, selective abstinence, and disclosure to sexual partners have all been demonstrated to reduce the risk of transmission.
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