Genital Herpes

Question 1

What are the 2 strains of herpes infection?

Answer 1

• HSV-1 and HSV-2
• responsible for both cold sores (herpes labialis) and genital herpes
• many people are infected without experiencing any symptoms

Question 2

What happens to the virus after initial infection?

Answer 2

• it becomes latent** in the associated **sensory nerve ganglia
• this is the trigeminal nerve ganglion in cold sores
• and the sacral nerve ganglion in genital herpes

Question 3

What other symptoms are associated with herpes simplex infection?

Answer 3

aphthous ulcers:

• small painful oral sores in the mouth

herpes keratitis:

• inflammation of the cornea

herpetic whitlow:

• painful skin lesion on a finger or thumb

Question 4

How is the herpes simplex virus spread?

Answer 4

• through direct contact with affected mucous membranes
• or viral shedding in mucous secretions

Question 5

Can herpes simplex be transmitted from an asymptomatic individual?

Answer 5

• the virus can be shed when no symptoms are present
• it can be contracted from an asymptomatic individual
• asymptomatic shedding is more common in the first 12 months of infection or where recurrent symptoms are present

Question 6

What is HSV-1 more associated with?

Answer 6

cold sores

• it is usually contracted in childhood before 5 years of age
• it remains dormant in the trigeminal nerve ganglion
• it reactivates as cold sores, particularly in times of stress

Question 7

What is HSV-2 more associated with?

Answer 7

genital herpes

• this is mostly a sexually transmitted infection but can also cause lesions in the mouth

Question 8

When do the symptoms of an initial infection tend to occur?

Answer 8

• symptoms appear within 2 weeks
• sometimes, no symptoms will be present
• or symptoms can develop months to years after an initial infection

Question 9

How does the severity of symptoms change over time?

Answer 9

• often the initial episode is the most severe
• recurrent episodes are milder** and **resolve more quickly

Question 10

What are the signs and symptoms of genital herpes infection?

Answer 10

• ulcers / blistering lesions in the genital area
• neuropathic type pain (tingling / burning / shooting)
• flu-like symptoms
• dysuria
• inguinal lymphadenopathy

Question 11

How long do symptoms last for?

Answer 11

• symptoms can last for 3 weeks in a primary infection
• recurrent episodes resolve more quickly

Question 12

How is a diagnosis of genital herpes made?

Answer 12

• clinical diagnosis based on history + examination findings
• viral PCR swab from a lesion can confirm the diagnosis

Question 13

What is the main treatment for genital herpes?

Answer 13

aciclovir

• alternatives are valaciclovir and famciclovir

Question 14

What additional measures to manage symptoms are recommended?

Answer 14

• paracetamol
• topical lidocaine 2% gel (e.g. Instillagel)
• cleaning with warm salt water
• topical vaseline
• additional oral fluids
• wear loose clothing
• avoid intercourse with symptoms

Question 15

What is the main risk associated with genital herpes and pregnancy?

Answer 15

• herpes is not associated with congenital abnormalities or pregnancy-related complications
• there is a risk of neonatal herpes simplex infection during labour / delivery

Question 16

What is the risk to the baby if a mother has genital herpes prior to pregnancy?

Answer 16

• the woman develops antibodies to the virus
• the antibodies cross the placenta and into the fetus
• this gives the fetus passive immunity to the virus and protects the baby during labour / delivery

Question 17

What is the treatment of primary genital herpes contracted before 28 weeks gestation?

Answer 17

Aciclovir

• following the initial infection, regular prophylactic aciclovir is given from 36 weeks gestation
• this reduces the risk of genital lesions during labour / delivery

Question 18

What is the recommendations around vaginal delivery in women with herpes infection?

Answer 18

• women who are asymptomatic at delivery can have a vaginal delivery
• it must be more than 6 weeks after the initial infection
• C-section is recommended if there are symptoms present** or primary infection occurs **after 28 weeks gestation

Question 19

How is primary genital herpes contracted after 28 weeks gestation treated?

Answer 19

aciclovir

• followed by immediate prophylactic aciclovir for the remainder of pregnancy
• LSCS is recommended in ALL cases