Background
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HSV 1/2
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traditionally HSV2 but cross over occuring
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recurent infection common
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periodic reactivation HSV 6x more frequently than HSV1
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HSV1 has a milder clinical course
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recurs \~ 1/yr
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HSV2 \~ 4-5 times in the year following first symptoatic episode
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HSV infection >1/12 suggests immunodeficiency
transmission:
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direct skin-skin contact
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viral shedding occurs most easily when sore present
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can occur if no symptoms
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most new infection transmitted via asymptomatic viral shedding
symptoms
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Asymptomatic
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painful genital lsions
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sometimes discharge
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20% have typical syndrome
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20% asymptomatic
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60% atypical
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vesicles and shallow ulcers
- inguinal lymphadeonapthy
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may have constitutional symptoms
testing
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viral swab should be taken
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negative swab doesn’t exlude infection
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determine HSV1/HSV2
- influence prognosis and counseling
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taken from genital lesion (de-roof any vesicles if necessary)
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issues in pregnancy:
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Referral recommended for women who have first clinical epsidoe during pregnancy as serology may be required
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prevalence in population increase with age
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Mothers with active infection pose high risk to thier infant when giving birth
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can cause servere systemic disease in neonates and those who are immune suppressed
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Ulcerative lesions can also facilitate transmisisno of HIV infection
First line
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aciclovir 200mg five times daily or 400mg tds for 5d (7d)
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safe in prgnancy
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started within 5d of onset while new lesions are forming
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lignocaine gel 2% for topical analgesia (not subs)
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oral anlgeisa may be required
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salt bathing to avoid adhesions