GENITAL HERPES

GENITAL HERPES

Definition

• Infections of the genital and surrounding areas

• Herpes simplex virus (HSV)

• Vesicles / erosion / ulceration in groups on the basis 

   of superficial erythematous

• Frequent relapses

• Sexually transmitted diseases, need attention:

   - It is hard to recover

   - Frequent recurrences

   - Transmission of the virus can occur from 

     asymptomatic patients

   - Effects on pregnancy and infant / fetus in the womb

   - The effect on immunocompromised patients

   - Impact of psychiatric

Etiology

• HSV 1

• HSV2

Herpes Simplex Virus

• HSV 1:

   - Contact nonsexual

   - 50-100% adult population

   - 80% Orolabial infection, 20% of genital

   - Early life

• HSV 2:

   - Sexual Contact

   - 5-95% adult population

   - 80% of genital, 20% Orolabial

   - Period of sexually active

Pathogenesis

• Exposure to HSV infection can occur:

- Episode I primary infection (initials)

- Episode I non primary infection

- Recurrent Infections

- Asymptomatic

- Not an infection

Primary infection

• Viru → host body

• There was merging with the host DNA

• Conducting multiplication / replication -> abnormalities in skin

• no specific antibodies

• extensive lesions, severe constitutional symptoms

• The virus propagates through sensory nerve fibers to 

   the sacral ganglion, silent and latent

Latent infection

• Without symptoms

• Basal ganglia

Factors Originator

• Trauma

• Excessive Coitus

• Fever

• Indigestion

• Stress the emotions

• Fatigue

• Food that stimulates

• Alcohol

• Drugs (immunosuppressive, corticosteroid)

Recurrent infections

• Opinions occurrence:

   - Trigger factors -> reactivation of the virus in the 

     ganglion. Virus down through peripheral nerve axons 

     to skin epithelial cells disarafinya, experiencing 

     replication, multiplication-> lesions

  - Virus continuously released into epithelial cells. 

    Originator + -> local weakness -> recurrent lesions

Clinical Symptoms

• The incubation period ranges from 3-7 days, much longer.

• The clinical manifestations are affected:

   - Factor host

   - Previous exposure to HSV

   - Episode History

   - Type of virus

• Symptoms can be asymptomatic severe, retrospective

  study 70% of asymptomatic HSV-2 infection

• Burning, itching lesion area (a few hours before the lesion +)

• After the lesions arise, constitutional symptoms (malaise,

  fever, muscle aches)

• Vesicles groups, easily broken -> multiple erosions, 

  erythematous base

• Secondary infection -> recover 5-7 days, scarring -

• Infection initials

   - Heavier, longer

   - Regional lymph nodes are enlarged, painful

   - Healing time -> 2-4 weeks, following attacks faster

   - Can occur dysuria (lesions in the urethra, periurethral),

      urinary retention can

   - Infection in the cervix -> change diffuse, multiple

     ulcers, large ulcers and necrotic. Can be asymptomatic.

• Recurrent infections

   - Can happen sooner or later

   - Symptoms lighter

   - Pain, itching +, + prodromal symptoms

   - Lesions are local

   - Healing faster 2 weeks

   - Specific antibodies +

• Place predilection:

- Men:

  • prepuce, glans penis, shaft of the penis, urethra, anal area.

  • The area of ​​the scrotum is rarely

- Women:

  • The labia major / minor, clitoris, introitus vagina, cervix

  • Perianal, buttocks, mons pubis rarely

Genital Herpes in Pregnancy

• Pregnant, arising genital herpes -> need attention

• Viruses -> placenta to the fetal circulation -> damage, 

  fetal death

• Infection neonatal mortality rate 60%.

• Half of neurological disability living, or eye disorders

• encephalitis, microcephaly, hydrocephaly, koroidoretinitis, 

  keratokonjunctivitis, hepatitis, skin lesions

• Transmission trimester I -> abortion, 2nd trimester -> 

  premature, intrapartum transmission

Genital herpes in immunodeficiency

•Abnormalities quite progressive → ulcers in anogenital

  region

• more extensive lesions

•Immunodeficiency not heavy → recurrence is more

  frequent, longer healing

Complication

• Most Dreaded → in newborns

   - Early pregnancy → abortion / congenital malformations

     (microcephaly)

   - Babies born, mother → genital herpes hepatitis, severe

      infections, encephalitis, keratokonjuntivitis, skin 

      eruptions, stillbirth

• Meningitis herpetika → HSV 2

• Encephalitis → HSV1

• Expansion of local spread of the virus ektragenital

Diagnosis

• Clinical:

   - Group of multiple vesicles, previous history of 

     similar lesions

   - Pain

• Differential diagnosis:

   - Ulcers due to Treponema pallidum,

   - Ulcers because Haemophylus ducrey

   - The cause of non-infectious

• The simplest, test tzank, paint Giemsa -> giant cell nuclei lot

• Electron microscopy -> herpes virus group indistinguishable

• Tissue culture -> the best way. High viral titers, positive

   results within 24-48 hours. Long and costly

• HSV antigen detection tests -> faster

    - In imunologik: immunofluorescent, 

      imunoperoksidase, ELISA

• ELISA, determine the presence of HSV antigen. 

   Sensitivity of 95%, very specific. Time of 4.5 hours. 

   Able for the detection of antibodies to HSV in serum

• Imunoperoksidase indirect, direct 

   immunofluorescence using polyclonal antibodies ->

   positive and false negative results. Monoclonal 

   antibodies in immunofluorescence -> determine the

   type of virus

• Imunoflouresensi indirect lesion scrapings, 

  sensitivity 78-88%

Management

• Purpose:

   - Prevent infection (prophylactic therapy)

   - Shortening the period of illness and frequency of 

     complications of primary infection

   - Prevent happen latency and clinical recurrence 

     after first episode

   - Preventing recurrences in asymptomatic

   - Reduce disease transmission

   - Eradication of latent infection

• Currently only a few objectives that can be met

Prophylaxis treatment

• Lighting the nature of the disease, can be transmitted 

  when any attack -> abstinensia

• individual protection, use a tool with a foam barrier 

  spermisidal and condoms.

• Avoiding precipitating factors

• psychiatric consultation, stress -> attack

Treatment of Non-Specific

• Pain and other symptoms with analgesic, antipyretic 

  and antipruritic

• The drying agent antiseptic, povidone iodine dry lesions, 

  prevent infection, speed up healing

• Antibiotics to prevent secondary infection

Specific Treatment

• Infection initials / first episode:

   - Acyclovir 200 mg orally, 5 times daily ver 7-10 days

   - Acyclovir 500 mg 3x / day

   - Or Valacyclovir, 500 mg orally, 2 times a day for 7 days

   - Reduces the formation of new lesions, reducing the

     length of pain, reduced wound penututupan time, 

     the proliferation of viruses.

- Does not affect the course of disease

Treatment

• Recurrent infections

   - Acyclovir, 200 mg orally, 5 times a day, for 5 days

   - Or Valacyclovir, 500 mg orally, 2 times a day, for 5 days

   - Or mild conditions, acyclovir cream.

   - Treatment done since the prodromal period or within

     1 day after the onset of lesions.

   - Treatment of genital lesions shortening

• Suppressive:

   - Acyclovir, 400 mg orally, 2 times a day, continuously.

   - Or valacyclovir, 500 mg orally, once daily

   - Treatment will reduce the frequency of relapse.

   - This treatment reduces but does not stop the 

     proliferation of the virus is asymptomatic

• disease with severe symptoms:

   - Acyclovir, 5-10 mg per kg of body weight, 

     given intravenously every 8 hours, for 7-10 days

     or until clinical improvement is achieved

• Co-infection with HIV:

   - It can include skin and mucosal ulceration or

     persistent and severe -> wide area

   - The lesions are very painful, atipis

   - Response by acyclovir +, the dose was increased 

     over a long period

   - Acyclovir 400 mg orally 3-5 times per day until 

     the lesions are healed.

 

 

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