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7.06 Genital Herpes Simplex


Presentation

The patient may be distraught with severe ganital pain or just concerned about paresthesias and subtle genital lesions, desirous of pain relief during a recurrence, or suffering complications such as superinfection or urinary retention. Instead of the classic grouped vesicles on an erythematous base, herpes in the genitals usually appears as groupings of 2-3mm ulcers, representing the bases of abraded vesicles. Resolving lesions are also less likely to crust on the genitals. Lesions can be tender, and should be examined with gloves on, because they shed infectious viral particles.

What to do:

Discussion

Currently there is no role for topical acyclovir in the treatment of genital herpes. Oral prophylaxis has been shown to be effective. Acyclovir is activated by phosphorylation inside infected cells and acts by blocking viral DNA replication, but it is ineffective once viral latency is established. Latent herpes virus DNA already residing in the sensory ganglia can cause recurrences with impunity, and topical acyclovir only decreases the amount of viral shedding. Famcyclovir is currently being used tid for zoster and is in clinical trials for herpes simplex.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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