Genital Herpes Flashcards

1
Q

Aetiology

A

HSV-1
HSV-2

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2
Q

Types of herpes

A
  • 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
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3
Q

Transmission

A

Spread through direct contact with affected mucous membranes or viral shedding in mucous secretions.

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4
Q

Can you contract HSV from ASx patients

A

Yes - shedding can occur in Asx Px
- ASx shedding more common in first 12 months of infection and where recurrent symptoms are present

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5
Q

Pathophysiology of cold sores

A

Initially contracted in childhood (<5)
Remains dormant in trigeminal nerve ganglion
- Reactivates as cold sores when stressed

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6
Q

Genital warts pathophysiology

A
  • 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
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7
Q

Clinical presentation

A
  • 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
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8
Q

Diagnosis

A
  • 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.
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9
Q

Treatment

A

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.

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10
Q

Pregnancy and genital herpes complications

A

Not known to cause pregnancy related Cx or congenital abnormalities
- Can cause neonatal HS infection = contracted during labour

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11
Q

Neonatal herpes simplex infection prognosis

A

High morbidity and mortality

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12
Q

Natural NHSI immunity

A

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

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13
Q

Medical management of primary genital herpes of pregnant women contracted < 28 weeks

A
  • 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
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14
Q

Medical management of primary genital herpes of pregnant women contracted > 28 weeks

A
  • 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.
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15
Q

Medical management of recurrent genital herpes of pregnant women

A

= 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

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