|
|
|
Genital Herpes
|
|
|
|
|
Vesicular herpes of the penile shaft. Multiple small blisters of the genitals, particularly when preceded by characteristic paraesthesia, are virtually diagnostic of herpes. |
Typical ulceration of the vestibule seen in a primary herpes attack. Multiple, shallow, uniform ulceration of the vestibule seen in a primary attack. Multiple, shallow, uniform ulceration of the genitals is highly suggestive of herpes infection. |
No treatment is available to eradicate the virus.
First episode
Antiviral agents reduce viral shedding from lesions, hasten healing and reduce the risk of recurrence while being administered. In the STD clinic valaciclovir is used with the aim of avoiding hospitalisation and/or reducing severe patient distress in acute first episode infection.
Standard therapy
valaciclovir 500 mg orally 12 hourly for 5 days (ADEC B3)
The patient should be reviewed after 5 days for resolution of symptoms A further 5 days of valaciclovir may be indicated.
For HSV proctitis
valaciclovir 1000mg orally 12 hourly for 7 to 10 days (ADEC B3)
Intermittent therapy
Most immunocompetent patients with recurrent disease do not benefit from intermittent antiviral therapy. If indicated, treatment should be instituted during the prodrome or within 2 days of onset of lesions.
valaciclovir 500 mg orally 12 hourly for 5 days
or
famciclovir 125 mg orally 12 hourly for 5 days (ADEC B3)
In patients with frequent or severe recurrences, daily suppressive therapy reduces the frequency of recurrences, although it does not totally eliminate symptomatic or asymptomatic viral shedding. Suppressive therapy with valaciclovir has also been shown to reduce the risk of transmission to sero-negative partners in monogamous relationships.
Standard therapy
valaciclovir
500 mg orally daily for a minimum of 6 to 12 months
(this dose may be increased to 500 mg twice daily if the patient has
recurrences
while on suppressive therapy)
or
famciclovir 250 mg orally 12 hourly for a minimum of 6 to 12 months
After
6 to 12 months, medication should be discontinued to allow evaluation of
the rate and severity of recurrences.
The
primary aim is supportive treatment by keeping lesions as clean and dry as
possible while spontaneous healing occurs.
This may be achieved by saline bathing (or other cleansing) of the
ulcerated area, drying with tissues, application of Betadine paint and/or exposing the ulcers to air or the warmth of a
reading light (a fan or hair dryer may be useful) for 10 to 15 minutes
several times a day, particularly after urination (for women).
Topical lignocaine, antiseptics and zinc creams should not be used.
Analgesics
by mouth are often useful, particularly at night time.
Hospitalisation
should be considered for patients who are in obvious distress from the
physical effects of their lesions, particularly when pain is aggravated by
walking or leads to urinary retention.
This pattern occurs mainly in first attacks involving widespread
ulceration of the vulval or perineal area.
Patient education is often complex. HSV is common with an approximate prevalence of 80-90% for type 1 and 20-30% for type 2. Up to 60-70% of people with HSV type 2 are not aware that they are infected. The risk of acquiring herpes from male to female is about 10% and female to male about 5% per annum in a serodiscordant relationship. The following points should be covered:
The nature of HSV infection including greater severity of initial attack, decreasing frequency and severity of recurrences with time
HSV type 1 and 2 infections are common in the community
Treatment options
Method of transmission
Nature of asymptomatic viral shedding during which time transmission may occur
Avoidance of sex during outbreaks and optional use of condoms at other times which may decrease transmission
For a pregnant woman to inform her treating doctor of her HSV infection.
Provide the patient with or recommend literature on genital herpes.
Provide test results
False negative results are common and do not exclude herpes in individuals with characteristic clinical signs. Patients with recurrent ulceration where HSV has not been isolated should be reviewed by a sexual health physician
Record clinical progress and perceived value of the therapeutic measures used
Enquire about any anxieties or further questions the patient may have.
|
Home | Search | Contents | About STD Services | Clinic 275 | Clinicians | Diseases | Notifications | Pamphlets | Statistics | Web Links | Your Sexual Health |
|
About
this web site
|
||
|
Sexually
Transmitted Diseases Services Telephone: +61 (8) 8222 5075 Please relace the word AT with the @ symbol to email comments. |
|
|
|