HERPES GENITALIS

Primary herpes simplex infection of the vulva. Courtesy Michael O. Murphy, MD Genital Herpes


See also herpes simplex. The term herpes genitalis refers to herpes of the genitalia. The majority of cases are caused by HSV-2 but some are caused by HSV-1.

Clinical

The classic appearance of grouped vesicles on an erythematous base is usually not seen. Instead, localized pain, erosions, or erythema all are common. Primary infection usually occurs in childhood and is asymptomatic. However, it can be very painful with individual outbreaks lasting from several days to a week. Recurrent episodes are often of shorter duration. Over time, recurrences tend to occur less often [AIM 1999;131;14]. Stressful events of at least 7 days duration significantly predict recurrences.

Asymptomatic Shedding

In a study of the drug pritelivir (NEJM 2014;Jan 15) untreated patients shed virus 16.6% of days. On pritelivir, they shed only 2.1% of days. In addition, pritelivir at 75 mg/day reduced the quantity of HSV DNBA in breakthrough shedding by more than 98%. Pritelivir inhibits HSV replication by targeting the HSV helicase-primase enzyme complex.

Treatment

For men, a condom should be worn until healing occurs. Unfortunately, asymptomatic shedding occurs and patients may transmit the virus through intercourse at any time.

Initial Infection

Recurrent Infection

Suppressive Therapy

Topical Zinc

Topical ZnSO4 has been found to be an effective therapeutic modality not only for treatment but also for prolonging remissions in herpes genitalis. Topical 4% ZnSO4 dissolved in distilled water has been found to be most efficacious out of the three concentrations, without any side effects. The protocol was to apply topical ZnSO4 on the first visit, then after every 5 days for 1 month, followed by every 10 days for 2 months and then after every 15 days for 3 months for the total period of 6 months. [Indian J Sex Transm Dis. 2013 Jan;34(1):32]

Additional Pictures

Herpes Genitalis of the vulva Herpes Genitalis of the vulva

Herpes Genitalis of the penis

Very common here.
Herpes Simplex of the buttocks Herpes Simplex of the Buttocks

References

Herpes simplex primary infection in a 5 month old boy Dermatology Online Journal 17(8).


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