GENITAL HERPES

Definition:

 Herpes simplex virus (usually HSV-2) infection involving the genitals

Classification:

1. Primary genital herpes: genital herpes due to HSV-1 or HSV-2 with

absence of antibody to HSV-1 or HSV-2 at time of infection
2. Non-primary first episode genital herpes: genital herpes due to HSV-2
with existing antibody to HSV-1 or genital herpes due to HSV-1 with
existing antibody to HSV-2
3. Recurrent genital herpes: reactivation of latent genital herpes with
existing antibody to the same HSV type recovered from the lesion

Etiology:

 Herpes simplex virus (HSV) causes genital ulcers and must be

differentiated from syphilis and chancroid
 Most HSV genital infections are due to type 2.
 Most often, intimate contact with someone shedding the virus leads to
infection.
 The incubation period is 5 to 7 days, after which small vesicles appear.
 During the initial infection, the HSV ascends the peripheral nerves to the
sacral plexus, where it resides permanently.

Signs and symptoms

 The initial infection is usually associated with malaise, regional

lymphadenopathy, and fever, which resolve in 1 wk.
 Burning genital pain
 Dysuria (female)
 Dyspareunia
 Lesions are extremely tender and heal in about 21 days.
 Recurrent infections, which tend to be milder and localized, are preceded
by a prodrome of numbness or tingling at the site.
 Viral shedding from recurrent lesions lasts 4 days, and lesions heal in
about 10 days.
Treatment

 Antiviral treatments shorten viral shedding by 1 day.

 For the initial infection, treatment is traditionally acyclovir 200 mg po 5
times/day for 10 days.
 Recurrences can be treated with 200 mg 5 times/day, 400 mg tid, or 800
mg bid.
 New oral antiviral drugs for the treatment of recurrent infections include
famciclovir 125 mg bid for 5 days and valacyclovir 500 mg bid for 5
days.
 About 70% of women have a recurrence within 1 yr.
 Long-term suppression with acyclovir 400 mg bid for 1 yr (after which it
is stopped and recurrences are assessed) should be considered for women
with multiple recurrences.