Types 1 and 2 of the herpes simplex virus may cause a genital herpes infection, although HSV type 2 is typically responsible for infections of the genital area in men and women.
Patients who are infected with the herpes simplex virus may not exhibit clinical symptoms.
Lesions or “fever blisters” may appear on the oral mucosa, or genitals. Lesions are usually small and vesicular. Lesions can be painful; however, painless lesions may also appear on infected sites. When the lesions rupture, a shallow, moist ulceration forms. Primary lesions persist for 17-20 days; however, new lesions may continue to develop for up to 6 weeks.
Blisters or vesicles associated with a genital herpes infection typically appear in clusters on the affected area.
Herpes blisters may be painful. Genital herpes lesions can also cause pain during urination.
Patients infected with the herpes virus may also experience flu-like symptoms including fever, headache, fatigue, muscle pain, and regional swelling of the lymph nodes. This typically occurs with the primary or initial episode of a genital herpes.
Acyclovir is not a cure for genital herpes; however, it can be used to reduce outbreaks/recurrences and to shorten a patient’s healing time and duration of viral shedding. It may be given to pregnant women who are at least 36 weeks gestation to prevent neonatal transmission of HSV.
Valacyclovir can be used to treat a genital herpes infection, but it is important to remember that it is not a cure. Valacyclovir works by inhibiting replication of the herpes virus.
Famciclovir can be used to treat both primary and recurrent herpes infections. This antiviral medication works by inhibiting replication of the herpes virus.
It is important to remember that patients are infectious during recurrences of the infection. Recurrences, however, are not caused by reinfection by the herpes virus, but rather due to viral shedding. Recurrences may be triggered by stress, fatigue, sunburn, acute illness, immunosuppression, and menses. Prodromal symptoms include tingling, burning, and itching at the site where lesions typically reappear. An HSV infection at the time of delivery poses a high risk of transmission to the neonate. At the time of delivery, if there are active genital lesions, a cesarean delivery may be indicated.
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