Genital herpes

Last Updated: 2021-10-18

Author(s): Anzengruber, Navarini

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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