Genital Herpes

Genital Herpes

  • HSV-1 (cold sores & ~15% of genital herpes lesions)
  • HSV-2 (genital & neonatal herpes)
    • Most of HSV-2 positive patients have unrecognized symptoms
  • Results from direct contact w/ active lesions/secretions
  • Incidence has been increasing
  • Route of transmission
    • Cutaneous HSV exposure
    • Acute Infection (symptomatic or asymptomatic)
    • Establishment of latent infection in dorsal root ganglia, innervating the mucosal areas involved in acute infection
    • Reactivation of HSV infection
    • Release of virus from latently infected dorsal root ganglia
    • Infection of epithelial cells –> mucosal ulcerations
    • Recurrent HSV –> clinical or subclinical
  • Viral shedding of HSV lasts ~ 12 days.  Symptoms:  vesticular pustule develops into a wet ulcer which develops into a dry crust & heals in ~ 20 days
  • Symptoms:  itching/burning/painful vesicular eruptions, flu-like symptoms, lymphadenopathy
  • Diagnosis:  tissue culture, antibody detection, based on clinical findings & history
 

First Episode of Genital Herpes

Recurrent/Episodic Genital Herpes

Suppressive Therapy for Genital Herpes

Severe Disseminated Herpes Simplex

Acyclovir (Zovirax)

400 mg PO TID or

200 mg PO 5x/day

Duration: 7-10 days

400 mg PO TID

Or

200 mg PO 5x/day

Or

800 mg PO BID for 5 days

Or

800 mg PO TID for 2 days

400 mg PO BID

Duration: indefinitely

5-10 mg/kg IV Q 8 h until clinical improvement followed up with at least 10 days of oral acyclovir therapy

Valacyclovir (Valtrex)

1 gram PO BID

Duration: 7-10 days

500 mg PO BID for 3 days

Or

1 gram PO QD for 5 days

500 mg PO QD

Or

1 gram PO QD

Duration: indefinitely

Not Indicated

Famciclovir (Famvir)

250 mg PO TID

Duration: 7-10 days

125 mg PO BID for 5 days

Or

1000 mg PO BID for 1 day

250 mg PO BID

Duration: Indefinitely

Not Indicated

  • Penicyclovir may be used topically for Herpes labialis applied Q 2 hours while awake. Topical acyclovir is general considered ineffective for Herpes labialis

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