Genital Herpes Flashcards
What is genital herpes?
It is a sexually transmitted infection caused by the herpes simplex virus (HSV)
What are the two main strains of herpes simplex virus?
HSV-1
HSV-2
What occurs during initial infection with herpes simplex virus?
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
How is the herpes simplex virus transmitted? (2 mechanisms)
Direct contact with affected mucous membranes
Viral shedding in mucous secretions
What clinical feature is HSV-1 associated with?
Cold sores
When is HSV-1 usually contracted?
Childhood
In which ganglion does HSV-1 tend to remain dormant in?
Trigeminal nerve ganglion
How can HSV-1 lead to genital herpes?
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
What strain of HSV is most commonly associated with genital herpes?
HSV-2
How does genital herpes tend to present?
Asymptomatically
After infection, how long does it take for genital herpes become symptomatic?
2 weeks
What are the six clinical features associated with genital herpes?
Dysuria
Itching
Burning/Tingling/Shooting Pain
Blistering Lesions, which appear as small red/white bumps in the genital area
Inguinal Lymphadenopathy
Flu-Like Symptoms
Which clinical feature is usually indicative of genital herpes, in comparison to other causes of genital ulcers?
Flu-like symptoms
What investigation is used to diagnose genital herpes?
Viral PCR Swab of Lesion
How is a viral PCR swab used to diagnose genital herpes?
It can confirm the diagnosis and causative organism
Do we manage or treat genital herpes?
Manage - it can not be cured
How do we pharmacologically manage genital herpes?
Antiviral medications
How do antivirals manage genital herpes? (3 mechanisms)
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
What do we administer to individuals during the initial outbreak of genital herpes?
Oral aciclovir 400mg three times daily for five days
This can be combined with a prescription of lidocaine ointment
What do we administer to individuals who experience infrequent recurrences of genital herpes?
Oral aciclovir 1.2g once daily until their symptoms are relieved
This can be combined with a prescription of lidocaine ointment
What do we administer to individuals who experience frequent recurrences of genital herpes?
Oral aciclovir 400 twice daily long term
What are the four complications of genital herpes?
Urinary Retention
Newborn Infection
Meningitis
Proctitis
What complication can arise when individuals who have genital herpes become pregnant?
There is a risk of neonatal herpes simplex infection contracted during labour and delivery
What happens when genital herpes is contracted prior to pregnancy?
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
How do manage individuals with recurrent genital herpes during pregnancy?
They are treated with prophylactic aciclovir from 36 weeks gestation to reduce the risk of symptoms at the time of delivery
How do we manage individuals who contract genital hepres before 28 weeks gestation?
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
How do we deliver babies whose mother contracted genital herpes before 28 weeks gestation?
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
How do we manage individuals who contract genital hepres after 28 weeks gestation?
It is treated with aciclovir followed immediately by regular prophylactic aciclovir
How do we deliver babies whose mother contracted genital herpes after 28 weeks gestation?
C-section is recommended in all cases
