Genital herpes
Genital herpes: Excerpt from Professional Guide to Diseases (Eighth Edition)
Genital herpes is an acute inflammatory disease of the genitalia. The prognosis varies, depending on the patient’s age, the strength of his immune defenses, and the infection site. Primary genital herpes is usually self-limiting but may cause painful local or systemic disease. (See Understanding the genital herpes cycle, page 1000.) In neonates and patients who are immunocompromised, such as those with acquired immunodeficiency syndrome, genital herpes is usually severe, resulting in complications and a high mortality.
Causes and incidence
Genital herpes is usually caused by infection with herpes simplex virus Type 2, but some studies report increasing incidence of infection with herpes simplex virus Type 1. This disease is typically transmitted through sexual intercourse, orogenital sexual activity, kissing, and hand-to-body contact. Pregnant women may transmit the infection to neonates during vaginal delivery if an active infection is present. Such transmitted infection may be localized (for instance, in the eyes) or disseminated and may be associated with central nervous system involvement.
An estimated 86 million people worldwide are thought to have genital herpes.
Signs and symptoms
After a 3- to 7-day incubation period, fluid-filled vesicles appear, usually on the cervix (the primary infection site) and possibly on the labia, perianal skin, vulva, or vagina of the female and on the glans penis, foreskin, or penile shaft of the male. Extragenital lesions may appear on the mouth or anus. In both males and females, the vesicles, usually painless at first, will rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, tender inguinal lymph nodes, and the characteristic yellow, oozing centers.
Other features of initial mucocutaneous infection include fever, malaise, dysuria and, in females, leukorrhea. Rare complications (generally from extragenital lesions) include herpetic keratitis, which may lead to blindness, and potentially fatal herpetic encephalitis.
Diagnosis
Diagnosis is based on the physical examination and patient history. Helpful (but nondiagnostic) measures include laboratory data showing increased antibody titers, smears of genital lesions showing atypical cells, and cytologic preparations (Tzanck test) that reveal giant cells.
CONFIRMING DIAGNOSIS Diagnosis can be confirmed by demonstration of the herpes simplex virus in vesicular fluid, using tissue culture techniques, or by antigen tests that identify specific antigens.
Treatment
Acyclovir has proved to be an effective treatment for genital herpes. I.V. administration may be required for patients who are hospitalized with severe genital herpes or for those who are immunocompromised and have a potentially life-threatening herpes infection. Oral acyclovir may be prescribed for the patient with a first-time infection or recurrent outbreak. Other agents include famciclovir, valacyclovir, and penciclovir; these drugs suppress symptoms but don’t cure the infection. Daily prophylaxis with acyclovir reduces the frequency of recurrences by at least 50%, but this is only appropriate for a patient with frequent outbreaks and may not decrease transmission rate of the disease.
Foscavir, a powerful antiviral agent, is the treatment of choice for herpes strains that are severe in nature or have become resistant to acyclovir and similar drugs. Administered I.V., foscavir can have several toxic effects, such as reversible impairment of kidney function or induction of sei-zures. As with other antiviral drugs, this drug doesn’t cure herpes.
Special considerations
❑ Encourage the patient to get adequate rest and nutrition and to keep the lesions dry.
❑ Tell the patient that warm baths may relieve the pain associated with genital lesions.
❑ Recommend gentle cleaning of the lesions with soap and water.
❑ Secondary infections of skin lesions by bacteria require a topical or oral antibiotic. Tell the patient to report worsening of lesions, indicating possible secondary infection, to the health care provider.
❑ Advise the patient to avoid sexual intercourse during the active stage of this disease (while lesions are present) and to use condoms during all sexual exposures. Urge him to have his sex partners seek medical examination.
❑ Advise the female patient to have a Papanicolaou test every 6 months.
❑ Refer patients to the Herpes Resource Center, which has local chapters nationwide, for support.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Ocular Herpes
More Medical Textbooks Online about Ocular Herpes
Review other book chapters online related to Ocular Herpes:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Herpes simplex (Professional Guide to Diseases (Eighth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
