Therapeutic Concern: HSV-2 Resistance Following Long-Term Antiviral Use

Herpes simplex viruses (HSV) are clinically significant pathogens that establish latent infections in humans. HSV-2 is a double-stranded DNA virus that commonly causes anogenital infections. HSV-2, sexually transmitted virus, can establish latency in ganglionic neurons and subsequently reactivating. Consequently, Genital herpes recurrences are common, usually milder than initial infections, but can significantly affect quality of life and mental well-being (1). Primary HSV infection can present with a wide range of symptoms including genital sores, itching, painful urination, urinary retention, vaginal or urethral discharge, headache, fever, and other systemic manifestations (2). Moreover, HSV-2 infection significantly elevates the risk of acquiring HIV, with those affected being around three times more likely to contract HIV than uninfected individuals. Genital HSV infections often goes asymptomatic or undiagnosed, as shown in a National Health and Nutrition Examination Survey, where only 13% of individuals with HSV-2 antibodies had received a genital herpes diagnosis. When genital lesions are present, HSV can be accurately diagnosed using type-specific molecular or virologic assays; in asymptomatic cases, serologic testing is useful for detecting type-specific antibodies. Antiviral therapy is advised for all patients experiencing a primary HSV infection. Management of recurrent genital herpes consists of episodic antiviral therapy, which involves taking medication during outbreaks, and suppressive therapy, which includes daily antiviral treatment to prevent recurrences, reduce viral shedding, and lower the risk of HSV transmission during sexual contact.(2, 3).