[11] Genital Herpes Flashcards
What is genital herpes?
A sexually transmitted infection caused by the herpes simplex virus
How is genital herpes transmitted?
By skin-to-skin contact through vagina, anal or oral sex
How long can genital herpes infection take to show?
Once infected people may be asymptomatic for a long period before the first flare up
What happens to the virus after resolution of primary genital herpes infection?
Can lie dormant until it returns in later life causing recurrent outbreaks
How many cases of genital herpes are there each year in England?
31,000
What % of newly diagnosed STI’s are genital herpes?
7%
What is happening to the rate of genital herpes infections?
Rising
What % of genital herpes occurs in people aged 15-24?
42%
Why are diagnostic rates and prevalence of genital herpes thought to be underestimated?
Many people don’t know they are infected
What are the 2 main types of herpes simplex virus?
HSV-1 and HSV-2
What can be caused by HSV-1?
- Cold sores
- Genital sores
What can be caused by HSV-2?
Genital herpes
What is the consequence of HSV-1 and 2 causing oral and genital herpes?
It can be spread via oral sex with a cold sore sufferer
How does HSV enter the body?
Via small cracks in the skin or through mucous membranes of the mouth, vagina, rectum, urethra or under the foreskin
Where does HSV travel after infecting the surface?
The nearest nerve ganglion and remains there
What does travelling to the nerve ganglion allow HSV to do?
Remain dormant for a long time
Why does remaining in the nerve ganglion allow the HSV to remain dormant?
It cannot be reached by the immune system
How does the HSV become reactivated?
It travels back down the nerve onto the surface of the genitals to cause a symptomatic outbreak
Can HSV be spread when asymptomatic?
Yes
How can HSV be spread when asymptomatic?
Through asymptomatic shedding
What are the risk factors for genital herpes?
- Multiple sexual partners
- Previous history of STIs
- Early age of first sexual intercourse
- Unprotected sexual encounters
- MSM (and female partners of MSM)
- Female gender
- HIV infection
What are the symptoms of primary genital herpes infection?
- Small, red, painful blisters around genitals
- Vaginal or penile discharge
- Flu-like symptoms, fever and myalgia
- Itchy genitals
What can happen to primary genital herpes blisters?
Can form open sores
Where do genital herpes sores present in men?
- Penis
- Anus
- Buttocks
- Thighs
Where do genital herpes sores present in women?
- Vulva
- Clitoris
- Buttocks
- Anus
How long does it take for primary genital herpes lesions to crust and heal?
20 days
How do secondary genital herpes infections differ from primary infection?
Often shorter and less severe and increasingly so with each infection
Why are secondary genital herpes outbreaks shorter and less severe?
Production of antibodies allows for a more effective response
What are the symptoms of recurrent outbreaks of genital herpes?
- Burning and itching
- Painful red blisters
What are cold sores?
Painful red blisters around the mouth and nose that last 7-10 days
What causes cold sores?
Mainly HSV-1 but also HSV-2
How can cold sores spread to cause genital herpes?
If oral sex received from someone with a cold sore
What are the differentials for genital herpes?
- Vulvovaginal candidiasis
- Other STI’s
- Scabies
- Psoriasis
- Dermatitis
- Reiter’s syndrome
- Genital malignancy
- Herpes zoster
Where is genital herpes best diagnosed?
During primary infection at a GUM clinic or GP surgery
What history should be taken to help diagnose genital herpes?
- Sexual partners
- History of cold sores or similar symptoms
- Any other STI’s
What investigation should be taken if patient presents with open genital herpes sores?
Swabs for testing presence of HSV and PCR to differentiate types 1 and 2
Is a negative swab a definite exclusion of genital herpes?
No
How can symptom duration of primary infection and recurrence of genital herpes be treated?
Over the counter medications
What mediation is effective at reducing the number and size of primary genital herpes lesions?
Aciclovir
What should a patient be offered after clearance of primary genital herpes infection?
Full sexual health screen and advice about preventing transmission
What advice should be given to patients with genital herpes?
Avoid all sexual contact during outbreak and disclose infection to all recent and current sexual partners
What can be used to reduce the discomfort of a genital herpes infection?
- OTC painkillers
- Petroleum jelly
- Ice pack
What is recommended if episodes of genital herpes are regular?
Take aciclovir as soon as symptoms start
What is recommended if episodes of genital herpes are very frequent?
Daily dose of aciclovir to suppress outbreaks
