HERPES SIMPLEX - Disease Management

An infection caused by herpes virus 1 or 2- which primarily affects the mouth or genital area. The virus may be transmitted even in the absence of symptoms or visible lesions. Once the virus is acquired, it spreads to nerve cells and remains dormant. It may intermittently reactivate and cause symptoms (flares). Recurrences may be precipitated by overexposure to sunlight, fever, stress, acute illness, and medications or conditions that weaken the immune system (such as cancer, HIV-AIDS, and use of corticosteroids). The herpes virus causes a wide range of diseases, including gingivostomatitis, keratoconjunctivitis, encephalitis, genital disease, and newborn infection.

Classification

• Herpes simplex virus 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus among the general population and is usually acquired in childhood.
• Herpes simplex virus 2 (HSV-2) is sexually transmitted and is usually associated with genital ulcers or sores.

Causes

• HSV-1- Transmitted through direct contact with infected saliva or direct contact with contaminated utensils
• HSV-2- usually acquired as an STD

Risk Factors

• Immune compromise
• Newborns
• Prior HSV infection
• Sexual contact with an infected person
• Occupational exposure

Signs and Symptoms

Lesions usually are vesicular or ulcerative on an erythematous base and are very painful. Many primary infections are asymptomatic. Recurrent lesions are common. Tender bilateral lymphadenopathy OCCurs with the lesions.

• Neurologic symptoms
• Headache
• Confusion
• Fever
• Tenesmus, itching with anal/perianal lesions
• Dysuria with genital lesions
• Sore throat with oral lesions
• Constitutional symptoms (usually present With the development of herpes lesions)
• Anorexia
• General malaise
• Prodromal symptoms (present in advance of herpes lesions)
• Burning
• Itching

DIAGNOSIS

Differential Diagnosis

• Chancroid
• .Pharyngitis
• .Proctitis
• Syphilis
• Male-Urethritis
• Hand-Foot-and-Mouth Disease
• Meningitis and Encephalitis

Investigations

• Tzanck smear
• Viral culture
• Serology
• CSF analysis
• CT scan
• MRI
• Lumbar puncture
• Brain biopsy
• Monoclonal antibody testin9
• Polymerase chain reaction
• Slit-lamp examination

TREATMENT

Goal

• To shorten the clinical course
• To prevent complications and the development
• of latency and/or subsequent recurrences
• To decrease transmission
• To eliminate established latency

Pharmacological Treatment

Class of drugs used is:

Antiviral agents:-

• Acyclovir
• Famciclovir

PATIENT EDUCATION

• Educate patients that Hsv-2 is an STD and advise to follow deterrence measures.
• Avoid contact with immune-compromised persons including neonates.
• Wash hands often to help prevent autoinoculation and spread to others.

Complications

• Encephalitis
• Neonatal infections
• Compromised host progressive and disseminated disease
• Genital infection acute urinary retention

Prognosis

• The high recurrence rate for genital HSV-2 infection.
• More than 85% of patients with one symptomatic episode will experience another.
• Recurrences may be frequent; 38% of the population with genital herpes have more than 6 recurrences per year; 20% have more than 10 recurrences per year.