Genital herpes is important not only because of its increasing incidence but also because of the physical and psychological trauma it can induce,the risk of serious complications including a possible link with cervical cancer and risk of maternal transfer to neonates.
Disseminated herpes in the newborn is certainly one of the most severe of all manifestations of herpes infections.Prematurity and spontaneous abortion have also been associated whit active maternal genital herpes.
Herpes simplex genitalis is most often caused by infection whit herpes simplex virus type 2,which has usually been sexually transmitted by an infected partner,but may possibly be trasmitted by orogenital contact.
Herpes simplex virus type 1 infection accounts for an increasing proportion of cases.Genital diseases caused by either of these viral types are clinically indistinguishable.As with other herpes infections,the virus replicates in the epithelium,giving rise to painful symptoms and signs.This typically follows a course which commences with redness and inflammation,leading to formation of vesicles which progress to multiple,small and shallow ulcers found on the labia and around the introitus and resolve with crusting and healing.This cycle may take up to 3 weeks in a primary infection.
After the primary infection the virus remains quiescent in the sacral ganglia and can re-emerge to cause recurrence at a later time.
The symptoms of recurrent genital herpes tend to milder and of shorter uration and are ofetn precede by prodromal phase consisting of cutaneous itching or burning and redness in the affected region.
The frequency of recurrences can vary from days to years.
Diagnosis and management:
When genital herpes is suspected it is important to confirm the diagnosis with laboratory culture.The natural history of the disease should be explained and advice given on genital hygiene.It is obviously important to trace sexual partners and would be wise to inform the obstetrician if the patient is pregnant.
Preparation including saline,gentian violet,ether and boric acid have been used for the topical treament of genital herpes.
Antiviral agents such as idoxuriene have also been tried but the results from controlled therapeutic trials have so far shown little clinical benefit from topical application of such drugs.
Many antiviral agents are toxic if ingested.
A standard cours of treatment is for 5 days,five times daily,but in the initial disease or severe recurrence the treatment may be extended up to 10 days.
Acryclovir cream is well tolerted and affective for out-patient management of genital herpes.The cream seems suitable patient initiated treatment which is important in a condition where recurrences are most effectively treated if the therapy is initiated at the first indication of recurrence.
If the secondary infection is present it should be treated.patient should be advised to have regular cervical smears and to avoid intercourse when lesions are present.
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