Genital Herpes

Microbiology

• Herpes simplex virus (Mainly type 2 (anogenital type)- although Type 1 now becoming more predominant as a cause for genital herpes)
• Usually sexually transmitted and symptoms classically occur 1 week post-exposure
  • Can be transmitted by oral sex, autoinnoculation,

Clinical picture

• Multiple small painful ulcers on genitalia (begin as small irritable vesicles which rupture)
  • These are usually painful and may cause dysuria, urethral or vaginal discharge or anal/perianal/rectal pain
• The primary infection may also have flu-like symptoms but can also be completely asymptomatic
• First episode tens to heal within 2-4 weeks without treatment
• Virus can lie dormant for long periods of time in the sacral ganglion
• Recurrence is common, and are usually decreasing in  frequency and may not be as severe (particularly of type 2 infection)
• Rarely, complications such as urinary retention (due to autonomic neuropathy) and aseptic meningitis can occur

Diagnosis

• Swab of deroofed vesicles/ulcers for HSV PCR
• NOT blood test (likely to be false positive in most individuals)

Management

• Aciclovir orally (200mg 5x/day)
• Lidocaine gel topically (for pain management)
• Discuss asymptomatic shedding with patients- even in bouts without symptoms the individual can still be infective
• Discuss risks in pregnancy- particularly primary infection during pregnancy as there will not be any maternal antibody present yet.

Management in Pregnancy

• In general- any episode in pregnancy should be treated with antivirals
• Vaginal delivery is ok for women who are asymptomatic in the third trimester/late pregnancy but caesarean section should be considered if there is a recurrence close to labour (>34 weeks)

Chancroid

• Chancroid is the most common cause of genital ulceration worldwide
• H ducreyi is an organism responsible
• Presents as an erythematous papular lesion which breaks down into a painful bleeding ulcer with a necrotic base and ragged edge
• Diagnosis is with lesion culture and PCR, which, in most cases, identifies H ducreyi
• Treatment is with either
  • Azithromycin 1g oral single dose
  • Ceftriaxone 250mg IM single dose
  • Ciprofloxacin 500mg oral single dose or 500mg oral BD for 3 days
  • Erythromycin 500mg oral QDS for 7 days (recommended also for patients with HIV)

Advertisement