Genital Herpes

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This a viral infection. Two types exist - Herpes Simplex type 1 (HSV-1) and Herpes Simplex type 2 (HSV-2). HSV-1 is associated with orofacial disease while HSV-2 is associated with genital disease. Both viruses can however cause either oral or genital lesions.

Causes

  • Herpes Simplex Virus
  • Gingivitis - the most striking feature, with markedly swollen, erythematous, friable gums
  • Anorexia, fever, malaise, headache, dysuria, sore throat, myalgia, pain, itching
  • Vesicular lesions (oral mucosa, tongue, and lips, vagina, penis, thighs and buttocks)
  • Tender regional lymphadenopathy

Investigations

  • HSV is best confirmed by isolation of the virus in tissue culture
  • PCR is more sensitive than culture and is preferred for CNS and ocular infections.

Treatment objectives

  • Manage symptoms and morbidity
  • Prevent complications

Pharmacological treatment

  • No cures available for either type
  • Antiviral treatment provides symptomatic relief and reduces duration of symptoms

1st line treatment

Acyclovir, oral,

Genital Herpes

Adult:

-      Initial treatment 400 mg every 8 hours for 7-10 days.

-      Intermittent treatment for recurrence 400 mg every 8 hours for 5 days

-      Chronic suppression for recurrence  400 mg every 12 hours for up to 12 months.

 

Pregnancy

-      Primary or first-episode infection 400 mg every 8 hours for 7-10 days

-      Symptomatic recurrent episode 400 mg every 8 hours for 5 days or 800 mg orally every 12 hours for 5 days

-      Daily suppression 400 mg orally, every 8 hours from 36 weeks estimated gestational age until delivery

-      Severe or disseminated disease 5-10 mg/kg, intravenously every 8 hours for 2-7 days, then oral therapy for primary infection to complete 10 days  

1st line treatment

Acyclovir

Neonates:

30 mg/kg/day IV divided every 8 hours for 14-21 days

 

Prevention

  • Advice on the use of condoms and treatment of sexual partners to prevent further spread
  • Strategies to prevent vertical HSV transmission:
    • Antiviral suppression for gravidas with first episode infection during pregnancy
    • Routine antiviral suppression for gravidas with a history of genital HSV
    • Identification of seronegative gravidas at risk of primary and non-primary first episode genital HSV infections.

Referral

  • Refer for specialist care in cases of complications like bacterial and fungal super-infections of the respiratory tract or CNS.