Herpes

Question 1

Rates of each type

Answer 1

70% = HSV1
30% = HSV2

Question 2

Symptoms

Answer 2

Worst on first presentation (milder in recurrence)

lesions 3-7 days after intercourse = red painful papule –> vesicles and ulcers
Lesions are infective
–> crusting and healing by 14 days

Cervical/vaginal involvement –> discharge
Flu like illness
Inguinal lymphadenopathy

Question 3

Investigations

Answer 3

Clincial Hx and appearance of rash

Gold standard = viral culture of vesicle fluid

Question 4

Management

Answer 4

No cure

During attacks:
Aciclovir - 400mg TDS for 5-10days

Anagesia (paracetamol)

Use condoms

Question 5

Complications

Answer 5

Local spread –> anus, fingers, eye (20%)

CNS - aseptic meningitis (common with HSV2 - 20%)

Autonomic dysfunction - difficulty micturating or defacating

Question 6

Complications in pregnancy

Answer 6

TORCH transmission –> herpes encephalitis

Question 7

Triggers for recurrence

Answer 7

Stress
Sex
Menstruation
OCP
Sunlight
Pregnancy
Sunlight
Trauma

Question 8

Recurrence rates

Answer 8

HSV1 = ~1 a year
HSV2 = ~ 4 a year