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