Herpes Simplex:
1. Small superficial ulcers on the glans penis. 2. A group of small vesicles on the shaft of penis.
1. Small superficial ulcers on the glans penis. 2. A group of small vesicles on the shaft of penis.
□Herpes Simplex is an acute, self-limited, intraepidermal vesicular eruption caused by infection with HSV.
□HSV is a medium-sized DNA virus that replicates within the nucleus.
□Based on culture and immunologic characteristics, it is divided into two types – HSV-1 and HSV-2.
□Usually, HSV-1 causes oral infection and HSV-2 causes genital infection.
□Primary infection with this viruses are characteristically followed by recurrent attacks.
Therapy of Herpes Simplex
First Episode– Primary
Acyclovir: 400 mg TID x 7 days or 5 mg/kg IV 8 hourly x 5-7 days or
Famcyclovir:250 mg TID x 7days or
Valacyclovir:1000 mg BID x 7 days.
Recurrent
Acyclovir: 400 mg TID x 5 days or
Famcyclovir:125 mg TID x days or
Valacyclovir: 500 mg BID x days.
Chronic Suppressive
Acyclovir: 400 mg BID or
Famcyclovir: 250 mg BID
Valacyclovir: 500 - 1000 mg OD
D/D of Herpes Simplex Genitalis
Herpes Zoster
►Herpes Simplex may be dermatomal in distribution and may be clinically identical to Herpes Zoster.
►A history of recurrences suggests HSV.
Primary Syphilis
►Classically, the lesion is painless.
►The border is indurated.
Chancroid
►Multiple painful ulcers.
Recurrent Herpes Simplex
►A prodrome of itching, burning, tingling, numbness or pain 1 to 2 days before a clinical outbreak.
►Lesions are localized and recur at the same anatomic site in each time.
►The duration is generally from 3 to 5 days.
►Regional adenopathy may be present.
►Vulvar involvement may cause dysuria.
►Chronic ulcerative lesions are indicative of immunosuppression.
Acyclovir-Resistant Herpes Simplex
►Seen in patient with AIDS.
►Co-resistance with Famcyclovir and Valacycloir has been reported.
►Foscarnet can be given(40 mg/kg IV 2 to 3 times daily for 14 to 21 days).
►Recurrent HSV after foscarnet treatment is often acyclovir sensitive.
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