1 / 28

Genital Herpes

Genital Herpes. Min Kim, MSN, APRN, ANP-BC. Overview. C ommon STD caused by herpes simplex virus C hronic, life-long viral infection Two serotypes: HSV-1 & HSV-2 Majority cases caused by HSV-2 HSV-1 is usually associated with oral lesions, but can cause genital herpes. Epidemiology.

rtroy
Download Presentation

Genital Herpes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. GenitalHerpes Min Kim, MSN, APRN, ANP-BC

  2. Overview • Common STD caused by herpes simplex virus • Chronic, life-long viral infection • Two serotypes: HSV-1 & HSV-2 • Majority cases caused by HSV-2 • HSV-1 is usually associated with oral lesions, but can cause genital herpes

  3. Epidemiology • At least 50 million persons in the United States infected • An estimated 81% of infected persons have not been diagnosed • 1.6 million new cases each year • More common in women than men, about 1 in 4 women vs 1 in 8 men

  4. Epidemiology(cont.) • Many persons have mild, asymptomatic, or unrecognized infections • Asymptomatic persons can shed virus intermittently in genital organs • Majority of HSV infections are transmitted by person unaware that they have infection

  5. Transmission • HSV-2 is transmitted sexually and perinatally • HSV-1 is usually transmitted via a non-sexual route; however, sexual transmission appears to be increasing • Risk of spreading the infection is much greater when a person has active signs or symptoms • Transmission can occur even if there are no visible ulcers

  6. Transmission(cont.) • Incubation period after acquisition is 2-12 days • Washing with soap and water readily inactivates HSV • There is no risk of becoming infected after exposure to environmental surfaces

  7. Clinical manifestationstypes of infection • Primary • Non-primary (non-primary first infection) • Recurrent

  8. Primaryinfection • The first infection ever with either HSV-1 or HSV-2 • No serum antibody is present when symptoms appear • More severe symptomsthan in recurrent disease. • Serum antibody may take several weeks to a few months to appear

  9. Non-primary first infection • Newly acquired infectionwith HSV-1 or HSV-2 in an individual previously seropositive to the other viral type • Type-specific antibody to the prior infection is present initially • Manifestations tend to be milder than those of primary infection

  10. Recurrent infection • Reactivation of genital HSV • The HSV type recovered in lesion is the same type as antibodies in the serum • Infection in which antibody is present when symptoms appear • May not be aware of previous episodes • Symptoms are mild and short in duration

  11. Signs and symptoms of primary infection • Numerous bilateral painful lesions • Lesions last average of 11-12 days • Typical lesion progression: papules, vesicles, pustules, ulcers, crusts, then healed • The median duration of viral shedding is about 12 days • Systemic symptoms peak within 3-4 days of onset of lesions and gradually recede over next 3-4 days (fever, headache, malaise, myalgia) • Local symptoms include pain, itching, dysuria, vaginal or urethral discharge, and tender inguinal lymphadenopathy

  12. Genital Herpes

  13. Latent stage • After initial outbreak, virus travels to a bundle of nerves at the base of the spine • Remains dormantfor a period of time • There are no symptoms during this stage • Triggers for recurrence — Illness, stress, sunlight, fatigue, and menstrual periods in women

  14. Signs and symptoms of recurrent infection • llness lasting 5-10 days • Prodromal symptoms (localized tingling, irritation) are common and begin 12-24 hours before lesions develop • Systemic symptoms usually absent • Duration of genital lesions is approximately 4-6 days • Average duration of viral shedding is 4 days • Lesions tend to be unilateral, and much less extensive than with primary infection • HSV-2 primary infection is more likely to recur than HSV-1 primary infection • Recurrences are more frequent if the primary episode is prolonged (i.e., greater than 30 days)

  15. Diagnosis • Clinical diagnosis of genital herpes should be confirmed with laboratory testing • Classical symptoms are often absent in many patients • Need to distinguish genital herpes from other STIs that also produce genital ulcers, such as syphilis and chancroid

  16. lab tests • Virologic tests • Type-specific serologic tests

  17. Virologic Tests Viral culture is gold standard for HSV diagnosis • Preferred if genital ulcers / lesions present • Most cultures will be positive within 24-72 hours Antigen detection • Better than culture for detecting HSV in healing lesions • The direct fluorescent antibody test distinguishes between HSV-1 and HSV-2 Cytology (Tzanck or Pap) identifies typical HSV-infected cells. It should not be relied upon for HSV diagnosis Polymerase Chain Reaction (PCR) assays • PCR is the preferred test for detecting HSV DNA in cerebral spinal fluid • Not FDA-cleared for testing of genital specimens • Not widely available, and may lack standardization across laboratories

  18. Type-Specific Serologic Tests Serologic tests • Detect Antibodies to HSV • HSV-2 antibody indicates anogenital infection as almost all HSV-2 infections are sexually acquired • HSV-1 antibody does not distinguish anogenital from orolabial infection Type-specific serologic assays might be useful when • Recurrent or atypical genital symptoms with negative cultures • A clinical diagnosis of genital herpes w/o laboratory confirmation • A sex partner with genital herpes • As part of a comprehensive evaluation for STDs among persons with multiple sex partners, HIV infection, and among MSM at increased risk for HIV acquisition

  19. Treatment • Antiviral drug therapy • Partially controls symptoms • Does not eradicate the virus • Does not affect the risk, frequency, or severity of recurrences after the drug is discontinued • Three oral meds: acyclovir, valacyclovir, and famciclovir • Topical antiviral treatment is of minimal clinical benefit, and it is not recommended

  20. Treatment for First Clinical Episode • Patients with first clinical episode genital herpes should receive antiviral therapy • Drastic effect on sxs, if sxs are of less than 7 day’s duration • Acyclovir 400 mg orally 3 times a day for 7-10 days, OR • Acyclovir 200 mg orally 5 times a day for 7-10 days, OR • Famciclovir 250 mg orally 3 times a day for 7-10 days, OR • Valacyclovir 1 g orally twice a day for 7-10 days • Treatment may be extended if healing is incomplete after 10 days of therapy

  21. Suppressive therapy • Can be administered continuously • Reduce the frequency of occurrences • Acyclovir 400 mg orally twice a day, OR • Famciclovir 250 mg orally twice a day, OR • Valacyclovir 500 mg orally once a day, OR • Valacyclovir 1 g orally once a day • Rebound outbreaks when suppression tx is discontinued • Suppression therapy does not eliminate latent infection

  22. Episodic therapy for recurrent Genital Herpes • Initiation of therapy within one day of lesion onset • Provide pt w/ appropriate meds or Rx in hand • Instruct pt to self-initiate tx immediately when sxs begin CDC recommendation • Acyclovir 400 mg orally 3 times a day for 5 days, OR • Acyclovir 800 mg orally twice a day for 5 days, OR • Acyclovir 800 mg orally 3 times a day for 2 days; OR • Famciclovir 125 mg orally twice a day for 5 days, OR • Famciclovir 1000 mg orally twice a day for 1 day, OR • Valacyclovir 500 mg orally twice a day for 3 days, OR • Valacyclovir 1 g orally once a day for 5 days

  23. Management of Severe Disease IV acyclovir • Severe HSV disease • Complications requiring hospitalization - disseminated infection, pneumonitis or hepatitis • Complications of the central nervous system - meningitis or encephalitis Herpes in HIV Infected Persons • May have prolonged or severe episodes • Increased doses of antiviral drugs may be beneficial

  24. Pt Counseling and Education • Helping patients cope with infection • Preventing sexual & perinatal transmission • Natural history of disease • Treatment options • Transmission • Prevention

  25. Prevention • Transmitted when lesions not present • Transmitted mostly during asymptomatic periods • Inform current SP about diagnosis with genital herpes • Inform future partners before initiating relationship • Abstain from sexual activity when lesions or prodromal sxs present • Avoid oral sex if ulcers or blisters around the mouth • Correct & consistent use of latex condoms reduce the risk • Suppressive tx reduces transmission when used by persons with multiple partners including MSM

  26. Neonatal herpes prevention • Risk of neonatal HSV infection should be explained to all patients, including men • Advise to inform prenatal & neonatal care providers • Advise pregnant women who are not infected with HSV-2 to avoid intercourse during the third trimester with men who have genital herpes

  27. References • Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006; 296:964. • Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med 1983; 98:958. 3. KimberlinDW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med 2004; 350:1970. • http://www.cdc.gov/std/treatment/2010/default.htm (Accessed on March 7, 2014) • SchillingerJA, McKinney CM, Garg R, et al. Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004. Sex Transm Dis 2008; 35:599. 6. Berger JR, Houff S. Neurological complications of herpes simplex virus type 2 infection. Arch Neurol 2008; 65:596. 7. Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370:2127.

More Related