[11] Genital Herpes

Question 1

What is genital herpes?

Answer 1

A sexually transmitted infection caused by the herpes simplex virus

Question 2

How is genital herpes transmitted?

Answer 2

By skin-to-skin contact through vagina, anal or oral sex

Question 3

How long can genital herpes infection take to show?

Answer 3

Once infected people may be asymptomatic for a long period before the first flare up

Question 4

What happens to the virus after resolution of primary genital herpes infection?

Answer 4

Can lie dormant until it returns in later life causing recurrent outbreaks

Question 5

How many cases of genital herpes are there each year in England?

Answer 5

31,000

Question 6

What % of newly diagnosed STI’s are genital herpes?

Answer 6

7%

Question 7

What is happening to the rate of genital herpes infections?

Answer 7

Rising

Question 8

What % of genital herpes occurs in people aged 15-24?

Answer 8

42%

Question 9

Why are diagnostic rates and prevalence of genital herpes thought to be underestimated?

Answer 9

Many people don’t know they are infected

Question 10

What are the 2 main types of herpes simplex virus?

Answer 10

HSV-1 and HSV-2

Question 11

What can be caused by HSV-1?

Answer 11

• Cold sores

- Genital sores

Question 12

What can be caused by HSV-2?

Answer 12

Genital herpes

Question 13

What is the consequence of HSV-1 and 2 causing oral and genital herpes?

Answer 13

It can be spread via oral sex with a cold sore sufferer

Question 14

How does HSV enter the body?

Answer 14

Via small cracks in the skin or through mucous membranes of the mouth, vagina, rectum, urethra or under the foreskin

Question 15

Where does HSV travel after infecting the surface?

Answer 15

The nearest nerve ganglion and remains there

Question 16

What does travelling to the nerve ganglion allow HSV to do?

Answer 16

Remain dormant for a long time

Question 17

Why does remaining in the nerve ganglion allow the HSV to remain dormant?

Answer 17

It cannot be reached by the immune system

Question 18

How does the HSV become reactivated?

Answer 18

It travels back down the nerve onto the surface of the genitals to cause a symptomatic outbreak

Question 19

Can HSV be spread when asymptomatic?

Answer 19

Yes

Question 20

How can HSV be spread when asymptomatic?

Answer 20

Through asymptomatic shedding

Question 21

What are the risk factors for genital herpes?

Answer 21

• 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

Question 22

What are the symptoms of primary genital herpes infection?

Answer 22

• Small, red, painful blisters around genitals
• Vaginal or penile discharge
• Flu-like symptoms, fever and myalgia
• Itchy genitals

Question 23

What can happen to primary genital herpes blisters?

Answer 23

Can form open sores

Question 24

Where do genital herpes sores present in men?

Answer 24

• Penis
• Anus
• Buttocks
• Thighs

Question 25

Where do genital herpes sores present in women?

Answer 25

• Vulva
• Clitoris
• Buttocks
• Anus

Question 26

How long does it take for primary genital herpes lesions to crust and heal?

Answer 26

20 days

Question 27

How do secondary genital herpes infections differ from primary infection?

Answer 27

Often shorter and less severe and increasingly so with each infection

Question 28

Why are secondary genital herpes outbreaks shorter and less severe?

Answer 28

Production of antibodies allows for a more effective response

Question 29

What are the symptoms of recurrent outbreaks of genital herpes?

Answer 29

• Burning and itching

- Painful red blisters

Question 30

What are cold sores?

Answer 30

Painful red blisters around the mouth and nose that last 7-10 days

Question 31

What causes cold sores?

Answer 31

Mainly HSV-1 but also HSV-2

Question 32

How can cold sores spread to cause genital herpes?

Answer 32

If oral sex received from someone with a cold sore

Question 33

What are the differentials for genital herpes?

Answer 33

• Vulvovaginal candidiasis
• Other STI’s
• Scabies
• Psoriasis
• Dermatitis
• Reiter’s syndrome
• Genital malignancy
• Herpes zoster

Question 34

Where is genital herpes best diagnosed?

Answer 34

During primary infection at a GUM clinic or GP surgery

Question 35

What history should be taken to help diagnose genital herpes?

Answer 35

• Sexual partners
• History of cold sores or similar symptoms
• Any other STI’s

Question 36

What investigation should be taken if patient presents with open genital herpes sores?

Answer 36

Swabs for testing presence of HSV and PCR to differentiate types 1 and 2

Question 37

Is a negative swab a definite exclusion of genital herpes?

Answer 37

No

Question 38

How can symptom duration of primary infection and recurrence of genital herpes be treated?

Answer 38

Over the counter medications

Question 39

What mediation is effective at reducing the number and size of primary genital herpes lesions?

Answer 39

Aciclovir

Question 40

What should a patient be offered after clearance of primary genital herpes infection?

Answer 40

Full sexual health screen and advice about preventing transmission

Question 41

What advice should be given to patients with genital herpes?

Answer 41

Avoid all sexual contact during outbreak and disclose infection to all recent and current sexual partners

Question 42

What can be used to reduce the discomfort of a genital herpes infection?

Answer 42

• OTC painkillers
• Petroleum jelly
• Ice pack

Question 43

What is recommended if episodes of genital herpes are regular?

Answer 43

Take aciclovir as soon as symptoms start

Question 44

What is recommended if episodes of genital herpes are very frequent?

Answer 44

Daily dose of aciclovir to suppress outbreaks