Genital herpes

Primary or secondary infection due to herpes simplex virus II (in 80-90% of cases) or HSV I (10-20%).

• Vulvovaginitis herpetica
• Cervicitis herpetica
• Proctitis herpetica
• Urethritis herpetica
• Balanitis or balanoposthitis herpetica

Transmission through skin to skin contact, mostly sexual intercourse / oral sex.

Genital redness and swelling with (often grouped localised) herpetiform vesicles, erosions and haemorrhagic crusts, sometimes painful, often severe itching; reduced AZ, fever, restlessness, vomiting.

• Clinical manifestion (exclude meningismus)
• If needed:
  • PCR or microtrack
  • Biopsy is rarely helpful

• Possible "peripartum" infection of the newborn in women
• Secondary infection with bacteria or candida

• Healing after 3-4 weeks
• Recurrences occur mainly in the first year after initial infection, with males showing symptoms more frequently

Recommendations:

• 1st line therapy: valaciclovir, aciclovir, famaciclovir
• 2nd line therapy: foscarnet, cidofovir
• 3rd line therapy: L-lysine, aspirin, topical imiquimod

Systemic therapy

• Aciclovir
  • dosage: 3x 5-10 (according to Lebwohl) mg/kg bw/d i.v. or 5x200mg per os depending on clinic
  • contraindications: hypersensitivity, lactation
  • adverse reactions (very common): headache
  • CAVE:
    • in elderly patients, there is an increased risk for the occurrence of reversible neurological disorders
    • adjust dosage if renal function is impaired
    • enough fluid intake

• Valaciclovir
  • dosage: 2x500mg daily p.o.for 10 days (initial infection), 5 days (relapse)
  • contraindications: hypersensitivity, lactation
  • adverse reactions (common): headache, nausea
  • CAVE:
    • adjustment of dosage in impaired renal function
    • hydration state

• Famciclovir
  • dosage: 500 mg 2x/d
  • in pat. >50, 500mg 3x/d should be given to prevent zoster neuralgia
  • independent on meals
  • interactions: probenecid
  • contraindications: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir
  • CAVE:
    • In patients at risk of dehydration, especially elderly patients, adequate hydration should be ensured
    • Efficacy may be reduced in black patients

• Brivudine
  • off-label-use
  • dosage: 125 mg 1x/d for 7 days
  • interactions: 5-fluorouracil preparations (time interval at least 4 weeks)
  • adverse reactions (common): nausea
  • contraindications: 5-fluorouracil- therapy, pregnancy, lactation, hypersensitivity to ingredient, not tested in children and adolescents

Topical therapy

• desiccative topiclas, i.e. iodine solutions

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