Genital Herpes

Aka: Genital Herpes, Herpes Simplex Virus 2, Herpes Genitalis, HSV II, Human Herpes Virus 2

1. See Also
   1. Primary Genital Herpes (Initial Genital Herpes)
   2. Secondary Genital Herpes (Recurrent Genital Herpes)
   3. Genital Herpes in Pregnancy
   4. Herpes Virus
   5. Oral Herpes
   6. Neonatal Herpes Simplex Virus
   7. Genital Ulcer
   8. Sexually Transmitted Disease
2. Epidemiology
   1. Most common cause of Genital Ulcer in United States
      1. Responsible for 60-70% of Genital Ulcers in sexually active patients
   2. Affects 10-30% of sexually active patients
   3. U.S. Prevalence: 30-45 Million
   4. U.S. Incidence: 300,000 new symptomatic cases yearly
   5. Not reportable
3. Pathophysiology
   1. Cause of Genital Herpes
      1. HSV II: 80-90%
      2. HSV I: 10-20%
   2. Associated with stressors
      1. Virus remains latent in spinal nerve roots
4. Signs
   1. See Primary Genital Herpes
   2. See Secondary Genital Herpes
   3. Vessicle
      1. Multiple vesicular lesions on foreskin, labia, vagina or anus
   4. Ulcer
      1. Painful shallow ulcers result when vessicles rupture
   5. Lymph
      1. Accompanied by lymhadenopathy with primary (first) infection
5. Diagnosis
   1. Clinical diagnosis
   2. See HSV Test
6. Management
   1. See Genital Herpes in Pregnancy
   2. Precautions
      1. Antivirals due not cure the infection
      2. Antivirals suppress symptoms and reduce viral shedding
   3. Primary Infection (Initial episode)
      1. See Primary Genital Herpes (Initial Genital Herpes)
   4. Recurrent Infection
      1. See Secondary Genital Herpes (Recurrent Genital Herpes)
   5. Suppression/Prophylaxis
      1. See Secondary Genital Herpes (Recurrent Genital Herpes)
   6. Pregnancy
      1. See Genital Herpes in Pregnancy
   7. General measures
      1. Keep infected area clean and dry
         1. Avoid secondary bacterial infections
         2. Avoid spread to uninvolved skin (autoinoculation)
      2. Wear comfortable clothing
         1. Loose fit
         2. Cotton underwear
      3. Apply an ice pack or baking soda compress to area
   8. Topical (systemic agents are preferred)
      1. Penciclovir 1% cream ($20 for 2g tube)
         1. Efficacy
            1. Significant shortens duration of pain, healing
            2. (1997) Med Lett Drugs Ther 39(Issue 1003):57-8
         2. Dosing
            1. Start at first prodromal symptom
            2. Continue every 2 hours while awake for 4 days
      2. Viscous Lidocaine
         1. Applied to genital lesions
         2. Can give significant relief
   9. Investigational
      1. L-lysine 1000 mg PO three times daily
      2. Aspirin 125 mg PO daily
      3. Local licorice root gels applied three times daily
      4. Lemon balm applied four times daily
      5. Zinc applied daily
      6. Aloe vera 0.5% applied three times daily
7. Prevention
   1. Avoid sexual contact during prodrome or when lesions
   2. Inform sexual partners of Genital Herpes
      1. Transmission can occur even when asymptomatic
   3. Condom use prevents transmission to women (not to men)
      1. Condom must cover active lesions
      2. Wald (2001) JAMA 285:3100-6
8. Course
   1. See Primary Genital Herpes
   2. See Secondary Genital Herpes
9. Resources
   1. Herpes Resource Center: (919) 361-8488
   2. Herpes Web
      1. http://www.herpesweb.net
   3. CDC Herpes site
      1. http://www.cdc.gov/std/herpes/stdfact-herpes.htm
10. References
    1. Beauman (2005) Am Fam Physician 72(8):1527-34
    2. Kimberlin (2004) N Engl J Med 350(19): 1970-7
    3. Nadelman (2000) Postgrad Med 107(3):189-95