Genital Herpes-Causes-Signs and Symptoms-Diagnosis-Treatment-Case Presentation-With an Example

HISTORY
PATIENT'S PROFILE:

PATIENTS NAME: Farzana AGE: 24yrs EDUCATION: Intermediate OCCUPATION: Housewife

HUSBANDS NAME:  Ahmed AGE:                    28yrs EDUCATION:    Bachelors OCCUPATION: Shopkeeper in supermarket Islamabad

PRESENTING COMPLAINTS

¬SEVERE DYSURIA __ 2days
¬DISTRESING PAIN IN VULVAR REGION__2days
¬RASH IN VULVAR REGION
¬VAGINAL DISCHARGE

HISTORY OF PRESENTING COMPLAINTS
¬ G3P2 at GA 23wk presented on 17th Aug 2009 with c/o severe dysuria and distressing pain localized to the vulvar region with the appearance of the rash in the vulvar region for the last two days
¬There is also vaginal discharge which is thin watery non-itchy and odourless
¬Also complains of malaise and body aches
¬There is no other associated systemic complaint
OBSTETRICAL HISTORY:
MARRIED FOR:
4 years
CONSANGUINITY:
negative
GRAVIDITY &PARITY:
LMP 1/3/2009 EDD 8/12/2009
G3 P2 A0
ALL SVDS at the hospital
all breastfed
all pregnancies labour and puerperium were uneventful
The ¬Last child born --- 3years ago
¬CONTRACEPTION
withdrawal and safe method

MENSTRUAL HISTORY:
LMP: 1/3/2009
Regular cycle
5/28 days
Normal flow
No dysmenorrhea
No intermenstrual bleeding
PAST MEDICAL AND SURGICAL HISTORY:
not significant
SOCIOECONOMIC STATUS:
middle class
PERSONAL HISTORY
nonaddict..had normal sleep and appetite
enjoys a healthy marital relationship
FAMILY HISTORY
not significant

EXAMINATION
SYSTEMIC EXAMINATION
GIT: normal
RESP: Bilaterally clear
CVS: S1 +S2
CNS: intact
MUSCULOSKELETAL: normal
LYMPH NODES: not enlarged

LOCAL EXAMINATION:
RASH:
¬dense vesicular lesions
¬small size (4 *4 cm)
¬extending from labias reaching up to thigh and anus
¬painful
¬non itching
URETHRA…. Normal
P/S exam……
introitus ….clear
cervix and vagina ….normal
slight thin clear discharge
No h/o discharge

genital herpes

PROVISIONAL DIAGNOSIS
Based on history and clinical examination my provisional diagnosis is
Herpes genitalis

What is genital herpes?
Definition: A viral STD that produces painful genital lesions
Etiology
Causative organism – Herpes Simplex Virus (HSV) is a DNA virus and Two strains of herpes virus exist
a)Type I (HSV I) – represents 5-10% of genital herpes lesions; primarily causes oral-labial lesions and resides in the trigeminal ganglion.(fever blisters)
b)Type II (HSV II) – causes 90-95% of all genital herpes lesions; lives in sacral dorsal root ganglia

Transmission
•through the skin to skin contact.
•Sexual contact
•at the time of birth
by a mother to her
baby.
How prevalent is genital herpes?
¬Accounts for 50-70% of genital ulcerative disease.
¬More common in women
¬More prevalent in blacks than whites
How is it clinically classified?
•Primary
•Nonprimary first-episode
•Recurrent
•Asymptomatic viral shedding

Primary episode
¬In a primary infection, no type-specific immunoglobulin G (IgG) antibodies to either HSV-1 or HSV-2 exist at the time of the outbreak.
¬This indicates that the patient had no prior exposure to HSV.
¬Typically, lesions appear 2-14 days after exposure
¬Antibody response occurs 3-4 weeks after the infection and is lifelong.

Nonprimary first-episode infections
¬nonprimary first-episode infection is a first genital HSV outbreak in a woman who has heterologous HSV antibodies
the partial protection of the preexisting antibodies, these women tend to have fewer and shorter systemic symptoms

Recurrent infections
A recurrent infection is defined as a genital HSV outbreak in a woman with homologous IgG antibodies to the HSV type

Clinical symptoms

¬1.Primary, first episode ¬a.Severely painful, usually multiple lesions on vulva, vagina, cervix, rectum, buttocks, penis or scrotum. ¬b.Systemic symptoms usually present (fever, chills, malaise, headache) ¬c.Vulvar pain, swelling ¬d.Dysuria and urinary retention ¬e.Duration of symptoms 12-20 days ¬f.Mean duration of viral shedding approximately 12 days

¬2.Recurrent lesions ¬Lesions are multiple, more localized, less severe ¬Systemic symptoms usually not present ¬Vulvar pain less severe ¬No adenopathy ¬Lesions typically last for 9 days ¬shedding lasts for approximately 4 days

What are diifferent obs complications
IN PRIMARY HERPES:
due to viremia there is increased risk of obs hazards
During first trimester:
¬spontaneous abortions
¬prematurity
During second trimester:
¬ neonatal morbidity..chrioretinitis
¬ meningitis
¬ Encephalitis
¬ Mental retardation
¬ Seizures
death
RECURRENT HERPES:
¬the risk of obstetric hazards is not increased and neonatal attack rate is only 4%
¬Neonates are infected through birth canal and can result in localized skin mouth and eye disease

HOW IS GENITAL HERPES DIAGNOSED?
¬On clinical picture
¬Viral culture from lesions:
¬Rapid diagnosis by Fluorescent antibody staining
¬Type specific antibodies differentiate between primary, non primary episodes
PCR can also be used

MANAGEMENT
¬Counseling:
¬Symptomatic treatment
analgesia
¬Management of pregnancy:
antiviral therapy
mode of delivery
Written, edited And Presented By
Dr. Amnah Abbasi