Herpes Simplex
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Herpes Simplex
Is a viral infection transmitted by direct contact, which is characterized by a localized primary lesion, latency, and recurrence. Lesions can be oral (lips, oral mucosae) or genital.
Cause
- Herpes simplex virus types 1 and 2
Oral herpes infection:
- Caused by HSV-1
- Mostly asymptomatic
- Painful blisters or open sores called ulcers in or around the mouth
- Sores on the lips (“cold sores.”) with tingling, itching or burning sensation around the mouth, before the appearance of sores.
Genital herpes
- Caused by HSV-2
- May be asymptomatic.
- There may be 1 or more genital or anal blisters or ulcers.
Differential diagnosis
- Aphthous ulcers
- Other causes of genital ulcer e.g. syphilis
Complications
- Keratitis (eye infection)
- Encephalitis
Investigations
- Diagnosis is clinical
- Swabs of blister fluids for viral studies
Treatment objectives
- Relieve itching
- Treat infection
- Prevent complications
Pharmacological treatment
For adults and adolescents with a first clinical episode of genital HSV infection
Clean lesions with antiseptic, e.g. chlorhexidine solution 0.05%
OR
Diluted hydrogen peroxide solution 6%
In severe or extensive infection
Acyclovir oral
Adult:
400 mg every 8 hours by mouth for 10 days
Child:
100-200 mg 5 times a day for 5-7 days
Dosages for pregnant women:
Acyclovir oral
400 mg orally thrice daily for 5 days
OR
800 mg twice daily for 5 days,
Dosages for people living with HIV and people who are immunocompromised:
Acyclovir oral
400 mg orally thrice daily for 5 days
Prevention
- Promote personal hygiene
- Avoid direct contact with infected people
- Advise patients to use condoms as applicable
Referral
- Refer patient for specialist care