I. Cutting-edge academic review Genital herpes is an inflammatory recurrent disease caused by herpes simplex virus (HSV) infection of the mucosal cells of the urogenital and anal skin. HSV is a DNA virus, type 2, with a sensory ganglia and latent infection, often latent in the sacral nerve root region. HSV-2 is the most common cause of genital herpes infection, but HSV-1 can also cause genital herpes. Genital herpes occurs in sexually active people aged 15-45 years, with a wide variety of lesions, and is more common in asymptomatic individuals, and in symptomatic individuals it can manifest as typical clusters of blisters, pustules, vesicles, ulcers and crusts, or as nonspecific erythema, papules, fissures, nodules, boils, folliculitis, skin abrasions, erythema and oozing, or vulvovaginitis in women. It has also been shown that HSV-2 is associated with the development of cervical cancer in women and can also activate HIV replication and increase the chance of HIV infection. Because HSV can remain latent in the nerve roots for a long time, the infection can last a lifetime and the virus is reactivated when the body’s resistance decreases and recurrence occurs. In studies of genital herpes recurrence, it has been found that NK cell activity is reduced in the recurrent group compared to the initial group, and CD4+ T cells are significantly lower in the recurrent group compared to the initial group, and there are also studies of cytokine changes in patients with recurrent genital herpes, suggesting that dysregulation of the Th1/Th2 balance in patients predisposes to disease recurrence. Pathogenic tests for HSV include viral culture, antigen detection, nucleic acid testing, and serum antibody testing, of which viral culture is the gold standard, with a high success rate for culture of incipient genital herpes and a high success rate for culture of blistering lesions. For suspected HSV infection without lesions or atypical lesions, antigen detection can be done by ELISA or immunofluorescence. Nucleic acid testing is more sensitive than antigen testing, but is limited by equipment and false positives, and is less routinely performed. Serum antibody testing can distinguish between viral types, but is influenced by a variety of factors such as infection status and methodology, and is only used as auxiliary diagnostic evidence, often in epidemiological investigations and retrospective clinical analysis. The main treatment for HSV is antiviral therapy, commonly used as acyclovir, famciclovir and valacyclovir. For patients with relapsing forms, in addition to viral suppressive therapy, the application of immunomodulatory drugs can be added to the treatment, and there are many reports of better efficacy obtained with combined immunotherapeutic approaches. Because neither antiviral therapy nor combination immunomodulatory drugs can achieve virus clearance, vaccine research is of great interest. Early inactivated vaccines have been eliminated because of their potential carcinogenicity; subunit vaccines have been tested in animals and humans and have some protective effect, but their efficacy is short-lived; DNA vaccines have been shown in animal experiments to have strong anti-infection and significant viral inhibition. Peptide vaccine and live genetically engineered vaccine with virus as carrier are the development trend of vaccine development, which will probably change the status quo that HSV cannot be prevented or cured. Clinical problems 1. Do all genital herpes have symptoms after infection? Among genital herpes patients with HSV-2 infection, 60% are symptomatic but atypical and unnoticed by patients or physicians, 20% have typical symptoms that can be detected, and 20% are asymptomatic subclinical infections, so although 80% of infected patients are symptomatic, only a small percentage are noticed. This requires clinicians to be alert to genital lesions and to consider the possibility of genital herpes in all cases where no other disease can be diagnosed. 2. Is there a meaningful serum antibody test for genital herpes? The serum antibody test for genital herpes is often used for epidemiological investigation and retrospective clinical analysis. It is not as diagnostic as microscopic examination of herpes fluid and culture, but the antibody test has exclusionary value, if the antibody test result is negative, it can be excluded that the lesion is genital herpes. If the IgM antibody is positive for IgG, it is more likely that the lesion is a first-time herpes infection, while if the IgM is negative for IgG, it can be assumed that despite having been infected with the herpes virus, it has not recurred for a longer period of time. Therefore, the antibody test combined with the clinical manifestations still has a secondary diagnostic value for genital herpes. 3. Is it possible for a patient with genital herpes to have children? For patients with initial genital herpes infection or frequent recurrences, it is recommended to avoid having children for a short period of time, and to use safety measures to avoid infecting partners if they are not infected, as the course of the disease is prolonged, the symptoms of herpes will be reduced and the interval between attacks will be prolonged, while some virus suppression therapy can reduce the recurrence rate to about 20% in six months. For male patients, fertility can be considered in this case, and for female patients, fertility can be considered after the initial stage of infection, with regular follow-up during pregnancy. 4. What are the risks of genital herpes during pregnancy and what are the preventive measures for neonatal infection? The chance of fetal infection due to first-episode genital herpes during pregnancy is 20%-50%, which can lead to fetal miscarriage, premature birth, intrauterine growth retardation, low birth weight and congenital asymptomatic HSV infection; the chance of fetal neonatal HSV in patients with recurrent genital herpes is less than 8%. Therefore, oral acyclovir or valacyclovir can be given to pregnant patients with first-episode, and frequent recurrences can be treated with acyclovir or valacyclovir near term to reduce disease activity; recurrent genital herpes without signs of recurrence near term can be left untreated; mothers with prodromal symptoms or active lesions can undergo cesarean section before rupture of membranes if not contraindicated, but cesarean section does not completely prevent neonatal The newborn should be closely monitored and treated promptly if suspicion is detected.