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% genital
- Early life
• HSV 2:
- Sexual Contact
- 5-95% adult population
- 80% 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 → Hospes body
• There was merging with the Hospes 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
• 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% genital
- Early life
• HSV 2:
- Sexual Contact
- 5-95% adult population
- 80% 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 → Hospes body
• There was merging with the Hospes 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
• 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 + ->
- 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 Hospes
- Previous exposure to HSV
- Episode History
- Type of virus
• Symptoms can be asymptomatic severe, retrospective study 70%
Clinical Symptoms
• The incubation period ranges from 3-7 days, much longer.
• The clinical manifestations are affected:
- Factor Hospes
- 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,
• 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,
• 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
• 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
- 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,
- 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, trimester 2 -> preterm,
• Transmission trimester I -> abortion, trimester 2 -> preterm,
intrapartum transmission
Genital herpes in immunodeficiency
• Abnormalities quite progressive → ulcers in anogenital region
• more extensive lesions
• Immunodeficiency not heavy → recurrence is more frequent, longer
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 → newborn
- Early pregnancy abortion → / Congenital malformations (microcephaly)
- Babies born, mother → genital herpes hepatitis, severe infections,
Complication
• Most Dreaded → newborn
- 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
• 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
• 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
• 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
• 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
• 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
- 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
• 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
• 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 for 7-10 days
- Acyclovir 3 x 500 mg / day
- Or Valacyclovir, 500 mg orally, 2 times a day for 7 days
- Reduces the formation of new lesions, reducing the length of pain,
• Antibiotics to prevent secondary infection
Specific Treatment
• Infection initials / first episode:
- Acyclovir 200 mg orally, 5 times daily for 7-10 days
- Acyclovir 3 x 500 mg / 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
- 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
• 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
- 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 / kg body weight, given intravenously every
• disease with severe symptoms:
- Acyclovir, 5-10 mg / kg 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
• 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.
- 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.
