1. Genital Herpes Prevention and Clinical Services: What Should Health Departments Do Now? H. Hunter Handsfield, M.D. University of Washington Public Health - Seattle & King County Seattle, Washington The Public Health Response to Genital Herpes: Where Do We Stand?

2. What Should Health Departments Do Now? What Should Health Departments Do Now? Diagnostic Testing and Screening Virologic Testing: Culture or PCR  Available in all STD settings  Routine diagnostic testing for all GUD  Routinely test overt herpes (for virus type) - May be optional for some patients, such as those with a clearly established pattern of frequent recurrences

3. What Should Health Departments Do Now? What Should Health Departments Do Now? Diagnostic Testing and Screening Glycoprotein G Serological Testing  Available in all STD settings  Routine diagnostic testing when virologic testing negative or outbreak poorly timed  Routinely recommended (not “offered”) - Patients with suggestive symptoms - Sex partners of persons with genital herpes - Persons at risk for sexual acquisition of HIV (MSM, IDU, heterosexual partners of HIV+) - HIV infected persons - Selected pregnant women (e.g., partner with GH)

4. What Should Health Departments Do Now? What Should Health Departments Do Now? Diagnostic Testing and Screening Glycoprotein G Serological Testing  Offer to persons who request comprehensive STD evaluation  Routine screening in STD clinics? - Probably not yet; consider routine “offer”  Minimal pre-test counseling: As for HIV, counseling requirements should not be a barrier to liberal use of serological tests, either for diagnosis or screening

5. What Should Health Departments Do Now? What Should Health Departments Do Now? Patient Education and Counseling  Natural course of disease  Subclinical shedding  Options to reduce transmission risk - Symptom recognition abstinence - Condoms - Antiviral therapy  Increased risk of HIV conferred by HSV-2  Neonatal herpes risks and prevention

6. What Should Health Departments Do Now? What Should Health Departments Do Now? Treatment  Acyclovir, valacyclovir or famciclovir should be routinely available in STD clinical settings  Treat all patients with initial genital herpes  Discuss suppressive therapy with all patients with HSV-2 infection  Prescribe suppressive therapy when appropriate - Symptomatic recurrences - Prevention of transmission

7. What Should Health Departments Do Now? What Should Health Departments Do Now? Pregnancy and Neonatal Herpes  Move toward systematic prevention of neonatal herpes - Broader screening to identify pregnant women at risk for initial herpes near term - HSV-2 positive: Reassure, look for lesions at term and avoid invasive obstetrical procedures - HSV-2 negative: test partner or abstain in third trimester  Support and implement neonatal herpes reporting