Genital Herpes

Question 1

Aetiology

Answer 1

HSV-1
HSV-2

Question 2

Types of herpes

Answer 2

• 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

Question 3

Transmission

Answer 3

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

Question 4

Can you contract HSV from ASx patients

Answer 4

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

Question 5

Pathophysiology of cold sores

Answer 5

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

Question 6

Genital warts pathophysiology

Answer 6

• 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

Question 7

Clinical presentation

Answer 7

• 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

Question 8

Diagnosis

Answer 8

• 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.

Question 9

Treatment

Answer 9

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.

Question 10

Pregnancy and genital herpes complications

Answer 10

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

Question 11

Neonatal herpes simplex infection prognosis

Answer 11

High morbidity and mortality

Question 12

Natural NHSI immunity

Answer 12

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

Question 13

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

Answer 13

• 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

Question 14

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

Answer 14

• 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.

Question 15

Medical management of recurrent genital herpes of pregnant women

Answer 15

= 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.