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.
Image
