Genital Herpes Simplex



Genital Herpes Simplex


Lamis Ibrahim

James W. Myers



INTRODUCTION



  • Herpes simplex virus (HSV) is the most prevalent cause of genital ulcer disease among sexually active people.


  • It is a chronic, lifelong viral infection and so presents with recurrent episodes.


  • HSV2 is almost always sexually transmitted.


  • HSV1 is usually acquired during childhood through nonsexual contacts.


  • Infections can be asymptomatic or unrecognized, but the patient can still shed the virus and transmit the disease.


EPIDEMIOLOGY



  • About 50 million people have genital herpes in the United States.


  • HSV2 is more common to cause genital infections (30% HSV1, 70% HSV2), although the incidence of HSV1 genital infection is probably increasing.


  • HSV2 is more likely to cause recurrent episodes.


  • Prior HSV1 infection can alleviate symptoms of subsequent HSV2 infection, and it can increase the chances of asymptomatic HSV2 infection by threefold.


  • Transmission occurs most commonly from asymptomatic patients or from those with unrecognized infection.


  • Risk of transmission increases with male source and with negative HSV antibodies.


  • Male latex condoms might reduce the risk for genital herpes transmission.


  • It increases risk of HIV acquisition and transmission.


  • HSV perinatal transmission can be associated with fetal mortality and morbidity.


CLINICAL MANIFESTATIONS


Primary Infection



  • Can be asymptomatic, subclinical, mild, or severe.


  • Incubation period is normally from 2 to 12 days.


  • Painful vesicular lesions/painful ulcers, and tender lymphadenopathy occur.


  • Lesions are usually multiple.


  • Fever, dysuria, and mucoid discharge can occur especially in females.


  • Can cause urethritis and cervicitis, which cannot be distinguished clinically from chlamydia and gonorrhea.


  • Usually more severe infections occur in female.


Recurrent Infection



  • Usually less severe and with fewer lesions than primary infection.


  • Has shorter duration of symptom and shorter duration of shedding.


  • Lesions may be preceded by a prodrome of tingling or pain.



  • Risk of frequent recurrences is higher with more severe and longer initial episode, in immunosuppressed, and with HSV2 compared to HSV1.


  • More common in males than females.


  • Median recurrence rates are four to five episodes per year, then a gradual decrease in rate over the years.


Proctitis



  • Especially in MSM (men who have sex with men).


  • Causes rectal pain, discharge, and tenesmus.


  • A perianal lesion may be present.



COMPLICATIONS



  • Aseptic meningitis and Mollaret syndrome (more common with HSV2)


  • Transverse myelitis especially in immunosuppressed patients.


  • Distant or extragenital lesions: more common with HSV1 infection.



    • Can be secondary to autoinoculation or reactivation. Can appear on buttocks, thigh, or face.


  • Autonomic dysfunction.


  • Superinfection (bacterial/fungal).


  • Disseminated infection.



DIAGNOSIS

1. Culture



  • Is the gold standard.


  • Highest yield with vesicular lesions.


  • Has low sensitivity (about 50%).


  • Typing should be done to detect the type of HSV when positive if possible.

2. PCR



  • Is more sensitive and is superior to virus isolation and culture.


  • Is not FDA approved.


  • Allows differentiation between HSV1 and HSV2.


  • Can detect asymptomatic shedding of the virus.

3. Type-specific serology



  • These are based upon glycoprotein G (G2 for HSV2 and G1 for HSV1)


  • Appear within the first week of infection and remain for life.

4. Cytological changes: nonspecific.


MANAGEMENT

Antiviral therapy controls signs and symptoms but does not eradicate the virus. It does not affect risk or frequency of recurrence after medication is stopped.

Treatment Regimens: See Table 12.1

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Jun 22, 2016 | Posted by in INFECTIOUS DISEASE | Comments Off on Genital Herpes Simplex

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