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% 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  

      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 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,  

   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, 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 

   healing

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

• 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 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

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 / 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  

      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.