Genital Tract Infection - Genital Herpes

Question 1

What is Herpes caused by?

Answer 1

Herpes Simplex Virus (HSV) - 2 main strains : HSV-1 and HSV-2.

Question 2

What can HSV cause? (2)

Answer 2

1. Herpes Labialis (Cold Sores).

2. Genital Herpes.

Question 3

Pathophysiology of HSV Infection (2).

Answer 3

1. Initial Infection.
2. Latent in Associated Sensory Nerve Ganglia (typically Trigeminal Nerve Ganglion with Cold Sores and Sacral Nerve Ganglia with Genital Herpes).

Question 4

Transmission of HSV.

Answer 4

Direct contact with affected mucous membranes or viral shedding in mucous secretions (even when asymptomatic).

Question 5

When is asymptomatic shedding common?

Answer 5

First 12 months of infection and where recurrent symptoms are present.

Question 6

Differences of Strains of HSV (2).

Answer 6

1. HSV-1 : Cold Sores (contracted initially in childhood before 5 and dormant in trigeminal nerve ganglion and reactivates particularly in times of stress and can cause Genital Herpes).
2. HSV-2 : Genital Herpes (usually an STI but can also cause lesions in the mouth).

Question 7

Clinical Features of HSV Infection (7).

Answer 7

1. Aphthous Ulcers (Small Painful Oral Sores in Mouth) - Gingivostomatitis.
2. Herpes Keratitis.
3. Herpetic Whitlow (Painful Skin Lesion on Finger/Thumb).
4. Neuropathic-Type Pain (Tingling, Burning, Shooting).
5. Flu-Like Symptoms.
6. Dysuria.
7. Inguinal Lymphadenopathy.

Question 8

Clinical Presentation of HSV Infection (3).

Answer 8

1. Initial Infection - within 2 weeks - symptoms can last for 3 weeks.
2. Initial Infection Severity > Recurrent Infection Severity.
3. Asymptomatic/Latent (mostly).

Question 9

Investigations of Genital Herpes (3).

Answer 9

1. Contact Tracing (Asymptomatic Shedding).
2. Clinical Diagnosis.
3. Viral PCR NAAT - Causative Organism.

Question 10

Management of Genital Herpes (6).

Answer 10

1. GUM Referral.
2. Aciclovir - Treat Genital Herpes - start within 5 days.
3. Paracetamol + Vaseline + Cleaning with Warm Salt Water.
4. Loose Clothing + Avoid Intercourse.
5. Lidocaine Topical.
6. Abstain from Sex when Symptomatic.

Question 11

Pregnancy and Genital Herpes RISK.

Answer 11

Risk of Neonatal HSV Infection contracted during labour and delivery (high morbidity and mortality).

Question 12

Pregnancy and Genital Herpes - Management of Primary Genital Herpes Before Week 28 (3).

Answer 12

1. Aciclovir Treatment.
2. Regular Prophylactic Aciclovir from Week 36.
3. Asymptomatic at Delivery : Vaginal Delivery (if more than 6 weeks since initial infection) - otherwise Caesarean.

Question 13

Pregnancy and Genital Herpes - Management of Primary Genital Herpes After Week 28 (3).

Answer 13

1. Aciclovir Treatment.
2. Regular Prophylactic Aciclovir Immediately.
3. Caesarean Always.

Question 14

Pregnancy and Genital Herpes - Management of Recurrent Genital Herpes.

Answer 14

Low Risk of Neonatal Infection : Regular Prophylactic Aciclovir from Week 36.