Genital Ulcer Disease Flashcards
What % of people get herpes symptoms at the time of catching the virus?
1/3
HSV incubation period
2 days- 2 weeks
Asymptomatic shedding accounts for what % of hsv transmission?
70%
How does prior HSV1 infection alter course of hsv 2 infection?
Less likely to have systemic symptoms likely to have shorter duration of signs and symptoms
Doesn’t effect recurrence rate
Whats the recurrence rate in 1st year of infection for HsV 1 and 2?
1: once a year
2: 4x a year
What factors can reactive the hsv?
Sun light
Immunocompromise
Fever
Others: uv light, menus, sex, exposure to heat or cold
What are other members of the human herpes vitus family other than HSV 1 and 2
HSV 6, 7, 8
Varicella zoster
CMV
EBV
What are complications of herpes disease?
Super infection
Urinary retention (due to pain or autonomic neuropathy)
Autoinnoculation
Aseptic meningitis
By how much does condom use reduce the transmission of HSV?
30-50%
By how much do antivirals reduce shedding?
90%
HSV associated with IRIS in PLWHIV may be unresponsive to treatment. What can you use in this case?
Foscarnet and cidofovir
Topical cidofovir 1% gel
How does treatment differ in PLWHIV?
Consider double the standard dose
Resistant strains of HSV have been seen in what % of PLWHIV?
5-7%
Resistance is most commonly related to what?
A mutation in the gene coding for HSV thymidine kinase
Is there an increased risk of miscarriage if hsv is acquired in the 1st trimester?
NO
What % of neonatal infections are limited to the skin? And when do they usually present?
30%
10-12 days post delivery
What are symptoms of disseminated disease kn neonates?
Jaundice Gi bleeding Resp distress Seizures CNS involvement
Whats the mortality rate and permanent neurological damage rate of disseminated infection in the newborn?
30% mortality
17% permanent neurology
Whats the mortality and neurological morbidity for hsv encephalitis in the newborn?
6% mortality
70% neurological morbidity
Lesions at onset of labour. Whats the risk of transmission
A primary episode
B recurrent lesions
A 41%
B 0.3%
Whats the neonatal management of
A) lscs to woman with primary hsv in 3rd trimester
B) SVD to woman with primary hsv in 3rd trimester
C) SVD to woman with recurrent hsv lesions at delivery
A liase with neonates and monitor for 24 hours
B swab skin, conjunctiva, oropharynx and rectum
Treat with iv aciclovir 8 hourly
Lp of unwell
C liase with neonates and monitor for 24 hours
Whats the treatment for donovanosis?
Azithromycin 1g weekly for 3 weeks or until lesions completely healed
PN for donovanosis?
6 months
Risks of donovanosis?
Increased risk of carcinoma of the penis
Dissemination is rare with spread to liver and bone (associated with pregnancy and cervical lesions)
Chancroid complications
Does NOT disseminate
Philosophy
Partial loss of tissue can rarely cause autpampitation of the penis
Chancroid treatment
Azithromycin 1g stat
Or
Ceftriaxone 250mg stat IM
PN for chancroid
10 days
Chancroid follow up
Re examine in 3-7 days
Ulcers should improve within 3 days and re epitheliaise within 7 days
Donovanosis treatment in pregnancy?
Erythromycin 500mg qds weekly for 3 weeks
Chancroid treatment for PLWHIV
Ciprofloxacin 500mg bd 3 days
Erythromycjn 500mg qds for 7 days
