2.5.10 Genital herpes simplex
Grading & Level of Importance: A
One of the most frequent sexually transmitted infections in Europe. Seroprevalence 15-20 % but varies substantially between countries. Incidence in Europe ranges from 5 to 24 per 100 persons per year. 1 in 5 adults have evidence of HSV-2 infection.
Primary infection or recurrence of the genital mucosa or adjacent skin by human herpes simplex virus (HSV) type 2 (or less commonly type 1).
Aetiology & Pathogenesis
Causative pathogens are HSV type mostly type 2, which both belong to the most common human viral infections worldwide. Clinical symptoms can be caused by primary infection or recurrences. After the primary infection, HSV remains latent in regional neuronal ganglia from where the virus spreads to the mucous membrane or skin epithelial cells via sensory neurons. HSV infection can recur spontaneously on different stimuli.
Signs & Symptoms
In males the most common clinical features are grouped vesicles and erosions on the glans /corona glandis penis and the shaft. The erosions are painful and, if untreated, can last 2-3 weeks. The inguinal lymph nodes can be tender and patients can have flu-like symptoms with fever and myalgia.
In females, the lesions tend to be more erosive and ulcerative. Typical sites are the vulvar area and the mucosae of the vagina and cervix. Many patients have dysuria and pelvic pain. Although infection may be asymptomatic in some cases, fever may occur and the disease course may be more severe in females.
Symptoms are usually milder and of shorter duration than in the primary infection; Can occur spontaneously or be triggered individual provoking factors: minor trauma (e.g. after sexual intercourse), genital infections (e.g. Candida-vaginitis), menstrual cycle (especially before menstrual bleeding), immunocompromised patients and emotional stress.
See symptoms. Anal intercourse can also lead to perianal and rectal HSV infection.
Based on causative agent HSV2 or less commonly HSV1 or on suspected clinical course as primary infection or a recurrence.
Laboratory & other workups
HSV can be detected from the skin and mucosal lesions of the skin by viral culture, HSV antigen test (direct immunofluorescence) or nucleic acid amplification tests. Serological tests are not helpful.
Usually not necessary.
In rare cases chronic neurogenic pain in the pelvic and genital areas. In pregnancy, genital herpes simplex can lead to infection of the fetus and should be managed by doctors of the maternity care or the obstetrician. Genital herpes increases the risk of HIV-transmission. Severe ulcerative and disseminated herpes infection possible in immunocompromised patients.
Based on typical clinical features and optional confirmatory microbiological tests. Additional HIV testing and screening for other STI should be undertaken.
Trauma-induced ulcers (e.g. during sexual intercourse), genital aphthae, herpes zoster (shingles), syphilis (primary chancre), ulcerative candida-infections, streptococci and weeping irritant and allergic contact dermatitis. In travel-related cases, chancroid (ulcus molle) and granuloma inguinale.
Prevention & Therapy
Barrier contraception may prevent the transmission of the infection.
Systemic anti-viral medicaments shorten symptomatic period and may decrease pain and itching caused by the infection. Antivirals should be started early when symptoms occur. Patients with frequent recurrences and high disease burden may profit from repeated courses or continuous antiviral medication.
Primary infection (course duration 3-10 days): acyclovir 400 mg t.i.d. or 200 mg q5h; valaciclovir 500 mg b.i.d.; famciclovir 250 mg t.i.d.
Recurrences (course duration 5 days): aciclovir 400 mg t.i.d. or 200 mg q5h; valaciclovir 500 mg b.i.d.; famciclovir 125 mg b.i.d.
Immunosuppressed patients may require initial administration of aciclovir intravenously 10 mg/kg body weight t.i.d.
Sexual activity should not take place until all lesions have healed.
- Which of the following statements are correct?
- Statement 1: A primary manifestation of herpes genitalis must be treated with an oral virostatic because
- Which one of the following is a potential differential diagnosis to Herpes genitalis?
- Which of the following statements is not correct?
- True or false?
- Which of the following statements are true?
- Which of the following statements are true?
- Statement 1 The initial manifestations of a genital herpes simplex infection should be treated with oral virostatic agents
- Which of these diseases must be considered in the differential diagnosis of herpes genitalis?
- Which answer best describes a primary herpes simplex infection?
- Which is the standard treatment for uncomplicated genital herpes simplex?
- Which of the following statements is false?
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