Presented by: Larry Stanberry. Center for Vaccine Development, The University of Texas Medical Branch at Galveston, TX, USA.

Broadly, prevention strategies can be divided into those aimed at reducing the risk of transmission or acquisition of genital herpes (GH) and those focused on reducing the frequency and severity of GH recurrences. Abstinence from oral, genital or anal sex would be expected to be an effective prevention strategy. Studies have shown that use of condoms or daily antiviral suppression with valaciclovir can reduce but not eliminate the risk of GH transmission/acquisition. Likewise, two studies indicated an experimental HSV vaccine can reduce the risk of HSV-seronegative women acquiring GH; however, the vaccine was not protective in HSV-1-seronegative women or in men. Another biomedical strategy in development is topical microbicides, products designed to be used intravaginally and/or intrarectally to prevent the acquisition or transmission of GH and other sexually transmitted infections. Regarding the prevention of recurrences in patients with GH, daily use of antiviral drugs including aciclovir, valaciclovir and famciclovir has been shown to significantly reduce the frequency of recurrences. A new strategy is the use of patient-initiated high-dose, shortduration episodic therapy. The choice of suppressive therapy versus high-dose short-duration patient-initiated episodic therapy should be determined by the management goals established through clinician–patient dialogue.