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Herpes Clinical Update

Herpes Clinical Update. Caroline Hewitt, MSN, NP Director of Clinical Education Cicatelli Associates Inc. Objectives. Review epidemiology and natural history of HSV Consider current diagnostic methods for HSV Discuss CDC treatment guidelines. Roberta. Epidemiology. Common

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Herpes Clinical Update

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  1. Herpes Clinical Update Caroline Hewitt, MSN, NP Director of Clinical Education Cicatelli Associates Inc

  2. Objectives • Review epidemiology and natural history of HSV • Consider current diagnostic methods for HSV • Discuss CDC treatment guidelines

  3. Roberta

  4. Epidemiology • Common • 25% of US population by age 35 • HSV-2: • Most cases subclinical • Transmission primarily from subclinical infection • Complications • neonatal transmission, enhanced HIV transmission, psychosocial issues

  5. Transmission • HSV-2 is transmitted sexually and perinatally • Asymptomatic • Efficiency greater from men to women than from women to men

  6. Transmission (continued) • Declines with increased duration of infection. • Incubation period after acquisition is 2-12 days (average is 4 days). • Facilitates both acquisition and transmission of HIV infection.

  7. Herpes: Primary Complex Source: Cincinnati STD/HIV Prevention Training Center

  8. Herpes: Genitalis External-Labia Minor Source: Cincinnati STD/HIV Prevention Training Center

  9. Herpes: Genitalis Clinical Periurethal Lesions on Vestibule Source: Cincinnati STD/HIV Prevention Training Center

  10. Herpes: Cervicitis Source: Cincinnati STD/HIV Prevention Training Center

  11. Herpes on the Buttock Source: Cincinnati STD/HIV Prevention Training Center

  12. Roberta • How to proceed? • Are you testing or screening? • Should you screen?

  13. Screening • Not recommended • Ethics of screening for asymptomatic herpes virus type 2 infection. Krantz I; Lowhagen GB; Ahlberg BM; Nilstun T SOBMJ 2004 Sep 11;329(7466):618-21.

  14. Types of Tests • Viral Culture • Polymerase chain reaction • Type-specific serologic tests

  15. Purpose for tests • To confirm clinical diagnosis • To diagnose unrecognized infection • To manage sex partners of persons with genital herpes

  16. CDC-Recommended Regimens for First Clinical Episode • 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 • CDC 2006

  17. CDC-Recommended Regimens for Episodic Therapy • Acyclovir 400 mg orally 3 times a day for 5 days, or • Acyclovir 200 mg orally 5 times a day for 5 days, or • Acyclovir 800 mg orally twice a day for 5 days, or • Famciclovir 125 mg orally twice a day for 5 days, or • Valacyclovir 500 mg orally twice a day for 3-5 days, or • Valacyclovir 1 g orally once a day for 5 days • CDC 2006

  18. CDC-Recommended Regimens for Suppressive Therapy • 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 • CDC 2006

  19. Sally W.

  20. “Suggestive of HSV” • Findings on Pap results unreliable • If history suggestive; draw serologies

  21. Yolanda

  22. Discussion • Atypical presentations of HSV • HSV 1 vs. HSV 2 • Counseling/education

  23. Conclusion

  24. Episodic Infection in HIV + Acyclovir 400 mg orally 3 times a day for 5-10 days, or Acyclovir 200 mg orally 5 times a day for 5-10 days, or Famciclovir 500 mg orally twice a day for 5-10 days, or Valacyclovir 1 g orally twice a day for 5-10 days CDC 2006

  25. Daily Suppressive Therapy in HIV + Acyclovir 400-800 mg orally twice a day or 3 times a day, or Famciclovir 500 mg orally twice a day, or Valacyclovir 500 mg orally twice a day CDC 2006

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