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cold sores usually heal themselves after a while. Type 1 infections generally do not involve genital areas of the body; type 2 infections do. acyclovir applied locally has been an effective form of treatment, with antibiotics often used to treat secondary infections. In persons with AIDS, herpes simplex sores require the intervention of other drugs to heal. Herpes simplex virus persists indefinitely in the body after initial infection and reactivates unpredictably. There is no known cure.

Herpes simplex type 1, caused by the herpes simplex virus 1 (HIV-1), commonly produces oral herpes, characterized by cold sores or fever blisters on the lips, in the mouth, or around the eyes.

Herpes simplex type 2, caused by the herpes simplex virus 2 (HSV-2), is a sexually transmitted herpes virus that causes painful sores in the anus or the genital area. Lesions usually appear two to twelve days after infection. In people with weakened immune systems, lesions may persist for a long period, are more extensive, and can result in severe ulcerations. Physicians use acyclovir to treat outbreaks of HSV-2 and as preventive therapy for people with deficient immune systems. foscarnet has been used to treat people with acyclovir-resistant herpes simplex infection.

Genital herpes may be chronic and recurring, and no known cure exists. It has been associated with an increased risk of acquiring HIV. Case reports suggest that persons with immunodeficiency have a more severe clinical course of anogenital herpes than do immunocompetent patients. Genital herpes can present as painful coalescing ulcerations requiring prophylactic maintenance therapy.

Genital ulcers should be considered in the differential diagnosis of any painful ulcerative genital lesion. Ulcerations from this disorder may increase the risk of transmission in women who are HIVnegative. Repeated or persistent treatment may be necessary to control symptoms; symptoms often recur when medication is discontinued.

Herpes simplex virus in the HIV-positive woman is often more persistent and requires higher doses of acyclovir than in the HIV-negative woman. Systematic acyclovir treatment provides partial control of the symptoms and signs of herpes episodes and accelerates healing. It does not eradicate the infection or affect the subsequent risk, frequency, or severity of recurrences after the drug is discontinued. Safety and efficacy have been documented among persons receiving daily acyclovir therapy for up to three years. Most episodes of recurrence do not benefit from therapy with acyclovir.

HIV infection should be considered a possibility in all women with recurrent or persistent herpes simplex. HIV-infected women have herpes simplex more often than women without HIV infection.

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