Genital Herpes Flashcards
Aetiology
HSV-1
HSV-2
Types of herpes
- Cold sores (herpes labialis) = HSV-1
- Genital herpes = HSV-2
- Aphthous ulcers = small painful oral sores in the mouth
- Herpes keratitis = inflammation of the cornea in the eye
Herpatic whitlow = painful skin lesion on a finger or thumb
Transmission
Spread through direct contact with affected mucous membranes or viral shedding in mucous secretions.
Can you contract HSV from ASx patients
Yes - shedding can occur in Asx Px
- ASx shedding more common in first 12 months of infection and where recurrent symptoms are present
Pathophysiology of cold sores
Initially contracted in childhood (<5)
Remains dormant in trigeminal nerve ganglion
- Reactivates as cold sores when stressed
Genital warts pathophysiology
- HSV-1 gential warts usually contracted via oro-genital sex = oral infection spread to genitals
- HSV-2 genital warts = STI = cause lesions in the mouth
Clinical presentation
- Can be ASx or develop Sx months/years after initial infection when latent virus reactivated
- Sx usually appear 2 weeks post = initial Px most severe with recurrent episodes milder
= Ulcers or blistering lesions affecting the genital area
= Neuropathic type pain (tingling, burning or shooting)
= Flu-like symptoms
= Dysuria
= Inguinal lymphadenopathy
Diagnosis
- Ask about sexual contacts, inc. those with cold sores.
- Clinical dx
- GOLD STANDARD = A viral PCR swab from a lesion can confirm the diagnosis and causative organism.
Treatment
GUM referral
ACICLOVIR
- Paracetamol
- Topical lidocaine 2% gel (e.g. Instillagel)
- Cleaning with warm salt water
- Topical vaseline
- Additional oral fluids
- Wear loose clothing
- Avoid intercourse with symptoms.
Pregnancy and genital herpes complications
Not known to cause pregnancy related Cx or congenital abnormalities
- Can cause neonatal HS infection = contracted during labour
Neonatal herpes simplex infection prognosis
High morbidity and mortality
Natural NHSI immunity
After initial infection mum develops antibodies
- During pregnancy antibodies can cross the placenta into the fetus.
- This gives the fetus passive immunity to the virus, and protects the baby during labour and delivery
Medical management of primary genital herpes of pregnant women contracted < 28 weeks
- Primary contracted <28 weeks = aciclovir during initial infection
- followed by prophylactic aciclovir starting from 36 weeks gestation onwards to reduce risk of genital lesions during labour and delivery.
- If Asx at time of labour = vaginal delivery safe
- If Sx = C-section
Medical management of primary genital herpes of pregnant women contracted > 28 weeks
- Aciclovir during the initial infection followed immediately by regular prophylactic aciclovir. Caesarean section is recommended in all cases to reduce the risk of neonatal infection.
Medical management of recurrent genital herpes of pregnant women
= Where the woman is known to have genital herpes before the pregnancy,
= carries a low risk of neonatal infection (0-3%), even if the lesions are present during delivery.
- Regular prophylactic aciclovir is considered from 36 weeks gestation to reduce the risk of symptoms at the time of delivery = daily suppressive aciclovir 400mg tds