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GENITAL HERPES

DEFINITION
Genital herpes (GH) one
of the more common
sexually transmitted
disease caused by herpes
simplex virus

ETIOLOGY

Human herpes virus type 2

EPIDEMIOLOGY

Incubation period : 3-9 days


Most frequently : young adult
95 % episode primary GH
occur following sexual
exposure a partner with
active lesions

20 50 % ulcerative
lesion in patients.
80 - 100 % middle
age aged adults of
lower socio-economic
30 50 % adults
higer socio- economic

CLINICAL MANIFESTATIONS

Episode primary genital herpes :


Symptoms : fever, malaise,
headache, other constitutional
symptoms.
Men : penis, scrotum, perianal
Women :mucous membrane
portion of vulva, may extend
labia majora & minora.

Lesion initially : small (1-3


mm), grouped vesicles
fragile & easily break
ulcerative lesions in 2-4
days.
Inguinal lymphadenopathy.

HSV have ability to remain


latent in neuronal cells in
ganglia can reactive
recurrent GH
Recurrent GH :
Less painful, more localized,
less often associated with
fever, arthralgia, & headache
than episode primary GH

Prodome : tingling, burning,


dysesthesias may occur 1-2
days before appearance of
vesicles.
Grouped vesicles quickly
develop into well-demarcated
erosions coalescing of
discrete erosions.

DIAGNOSIS

Typical : painful multiple


vesicular or ulcerative lesions
Tzanks preparations
Isolation of HSV in cell culture
sensitivity declines rapidly
as lesion begin on heal
PCR assay for HSV DNA
highly sensitive

DIFFERENTIAL DIAGNOSIS

Chancroid.
Lymphogranuloma
venerum.
Granuloma inguinale.
Gonorrhea.
Syphilis.

TREATMENT
Primary genital herpes :
Acyclovir :
Intravenous : 5 mg/kg q8h.
Oral : 400 mg PO 5 times/d.
Topical use : 5 % ointment
in polythylene glycol.
Valacyclovir : oral 500 mg po
bid for 5 days.

Recurrent genital herpes :

Acyclovir : oral 200 mg five


times daily for 5 days.

Famciclovir : oral 500 mg


given 5 times/d for 7 days.

Immunotherapy :

Administration of HSV
vaccines with varying
adjuvant has been associated
with reduction in the
frequency of reactivation.

gD2 vaccine in alum was shown


to reduce the recurrence rate of
genital HSV by 25%.

A recombinant gD2-gB2 vaccine


in MF-59 reduced the severity
of the HSV recurrence.

Prophylaxis of infection :

Barrier forms of
contraception, especially
condoms, may decrease
transmission of disease.

An effective HSV vaccine is


the best approach to the
prevention of HSV.

REGIMENS OF CDC

First episodes of GH :
Acyclovir 400 mg orally 3
times a day (7-10 days)
Acyclovir 200 mg orally 5
times a day (7-10 days)
Famciclovir 250 mg orally 3
times a day (7-10 days)
Valacyclovir 1 g orally twice
a day (7-10 days)

REGIMENS OF CDC

Recurrent episodes of GH :
Acyclovir 400 mg orally 3
times a day (5 days)
Acyclovir 200 mg orally 5
times a day (5 days)
Acyclovir 800 mg orally
twice a day (5 days)

REGIMENS OF CDC
-

Famciclovir 125 mg orally


twice a day (5 days)
Valacyclovir 500 mg orally
twice a day (3-5 days)
Valacyclovir 1 g orally
once a day (5 days)

REGIMENS OF CDC

Suppresive therapy for recurrent


GH :
Acyclovir 400 mg orally twice a day
Famciclovir 250 mg orally twice a
day
Valacyclovir 500 mg orally once a
day
Valacyclovir 1 g orally once a day

REGIMENS OF CDC

Severe disease :
Acyclovir 5-10 mg/kg body
weight IV every 8 hours (2-7
days) or until clinical
improvement
Followed by oral antiviral
therapy to complete at least 10
days total therapy

COUNSELLING & FOLLOW-UP

Information of the natural history of


disease potential recurrent attacks, the
role of asymptomatic shedding in sexual
transmission
Information on antiviral treatment
available
Abstain from sexual activity during
prodromal symptoms or when lesion are
presents

Advice to inform current & new sexual


partners of GH
Use condoms with new or uninfected
partners, particularly in the first 12
months after the first attack
Risk of neonatal infections should
inform their doctors early in pregnancy