Genital Herpes

Question 1

What is genital herpes?

Answer 1

It is a sexually transmitted infection caused by the herpes simplex virus (HSV)

Question 2

What are the two main strains of herpes simplex virus?

Answer 2

HSV-1

HSV-2

Question 3

What occurs during initial infection with herpes simplex virus?

Answer 3

The virus becomes latent in the associated sensory nerve ganglia, which in most cases occurs in the sacral nerve ganglia

The virus lies dormant in the body and can reactivate several times a year - usually during times of stress

Question 4

How is the herpes simplex virus transmitted? (2 mechanisms)

Answer 4

Direct contact with affected mucous membranes

Viral shedding in mucous secretions

Question 5

What clinical feature is HSV-1 associated with?

Answer 5

Cold sores

Question 6

When is HSV-1 usually contracted?

Answer 6

Childhood

Question 7

In which ganglion does HSV-1 tend to remain dormant in?

Answer 7

Trigeminal nerve ganglion

Question 8

How can HSV-1 lead to genital herpes?

Answer 8

It is usually contracted through oro-genital sex, where the virus spreads from a person with an oral infection to the person that develops the genital infection

Question 9

What strain of HSV is most commonly associated with genital herpes?

Answer 9

HSV-2

Question 10

How does genital herpes tend to present?

Answer 10

Asymptomatically

Question 11

After infection, how long does it take for genital herpes become symptomatic?

Answer 11

2 weeks

Question 12

What are the six clinical features associated with genital herpes?

Answer 12

Dysuria

Itching

Burning/Tingling/Shooting Pain

Blistering Lesions, which appear as small red/white bumps in the genital area

Inguinal Lymphadenopathy

Flu-Like Symptoms

Question 13

Which clinical feature is usually indicative of genital herpes, in comparison to other causes of genital ulcers?

Answer 13

Flu-like symptoms

Question 14

What investigation is used to diagnose genital herpes?

Answer 14

Viral PCR Swab of Lesion

Question 15

How is a viral PCR swab used to diagnose genital herpes?

Answer 15

It can confirm the diagnosis and causative organism

Question 16

Do we manage or treat genital herpes?

Answer 16

Manage - it can not be cured

Question 17

How do we pharmacologically manage genital herpes?

Answer 17

Antiviral medications

Question 18

How do antivirals manage genital herpes? (3 mechanisms)

Answer 18

It helps sores heal sooner during an initial outbreak,

It reduces the severity and duration of symptoms in recurrent outbreaks

It reduces the frequency of recurrence

Question 19

What do we administer to individuals during the initial outbreak of genital herpes?

Answer 19

Oral aciclovir 400mg three times daily for five days

This can be combined with a prescription of lidocaine ointment

Question 20

What do we administer to individuals who experience infrequent recurrences of genital herpes?

Answer 20

Oral aciclovir 1.2g once daily until their symptoms are relieved

This can be combined with a prescription of lidocaine ointment

Question 21

What do we administer to individuals who experience frequent recurrences of genital herpes?

Answer 21

Oral aciclovir 400 twice daily long term

Question 22

What are the four complications of genital herpes?

Answer 22

Urinary Retention

Newborn Infection

Meningitis

Proctitis

Question 23

What complication can arise when individuals who have genital herpes become pregnant?

Answer 23

There is a risk of neonatal herpes simplex infection contracted during labour and delivery

Question 24

What happens when genital herpes is contracted prior to pregnancy?

Answer 24

The genital herpes 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 25

How do manage individuals with recurrent genital herpes during pregnancy?

Answer 25

They are treated with prophylactic aciclovir from 36 weeks gestation to reduce the risk of symptoms at the time of delivery

Question 26

How do we manage individuals who contract genital hepres before 28 weeks gestation?

Answer 26

It is treated with aciclovir during the initial infection

This is followed by regular prophylactic aciclovir starting from 36 weeks gestation onwards to reduce the risk of genital lesions during labour and delivery

Question 27

How do we deliver babies whose mother contracted genital herpes before 28 weeks gestation?

Answer 27

If women are asymptomatic at time of delivery and their initial infection was more than six weeks ago, vaginal delivery can occur

However, if symptomatic, a c-section is advised

Question 28

How do we manage individuals who contract genital hepres after 28 weeks gestation?

Answer 28

It is treated with aciclovir followed immediately by regular prophylactic aciclovir

Question 29

How do we deliver babies whose mother contracted genital herpes after 28 weeks gestation?

Answer 29

C-section is recommended in all cases