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Genital herpes

Definition
Genital herpes is a sexually transmitted viral infection characterized by primary and recurrent genital inflammation and lesions.
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Pathophysiology
Genital herpes is mostly caused by HSV-2 and HSV-1 transmitted through sexual contact.
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Epidemiology
The incidence of genital herpes in North America is estimated to range from 5,000 to 24,000 per 100,000 people per year.
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Disease course
Clinical manifestations include lesions of mucous membrane presenting as bilateral clusters of macules, papules, followed by vesicles, pustules, and ulcers on the external genitalia with symptoms of pain, itching, burning, dysuria, lymphadenopathy, fever, cervicitis (women), and proctitis (homosexual men). Complications in women include aseptic meningitis and urinary retention. Recurrent episodes may show prodromal symptoms of paresthesia and pains in the area of lumbosacral dermatomes. Asymptomatic genital shedding without any clinical symptoms is quite frequent. The disease increases psychological stress with frequent recurrences.
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Prognosis and risk of recurrence
Untreated pregnancy-related genital herpes is associated with a mortality of 0.062 per 1,000 births in neonates.
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Key sources
The following summarized guidelines for the evaluation and management of genital herpes are prepared by our editorial team based on guidelines from the U.S. Preventive Services Task Force (USPSTF 2023; 2014), the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2023; 2018), the Center for Disease Control (CDC 2021), the French National College of Gynecologists and Obstetricians (CNGOF 2018), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2017), and the World Health Organization (WHO 2016).
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Guidelines

1.Screening and diagnosis

Indications for screening: do not obtain routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant persons.
D
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2.Diagnostic investigations

Laboratory testing: obtain laboratory testing to confirm the diagnosis of genital herpes.
B

3.Medical management

Management of first episode
As per CDC 2021 guidelines:
Administer any of the following antiviral regimens for 7-10 days in patients with a first clinical episode of genital herpes:
Situation
Guidance
Acyclovir
400 mg PO TID
Famciclovir
250 mg PO TID
Valacyclovir
1,000 mg PO BID
E
Consider extending treatment if healing is incomplete after 10 days of therapy.
E

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  • Management of recurrent episode

4.Specific circumstances

Pregnant patients, evaluation, CNGOF
Do not obtain virologic confirmation for genital herpes lesions during pregnancy in patients with a history of genital herpes.
D
Obtain virological confirmation with PCR and assess for the specific IgG type in pregnant patients with genital lesions with no previous history of genital herpes.
E

More topics in this section

  • Pregnant patients (suppressive therapy)

  • Pregnant patients (antiviral therapy)

  • Pregnant patients (considerations for delivery)

  • Patients with HIV (primary prevention)

  • Patients with HIV (suppressive therapy)

  • Patients with HIV (antiviral therapy)

  • Patients with HIV (pregnant patients)

  • Patients with HIV (pediatric patients)

  • Neonate patients

5.Patient education

General counseling: as per SOGC 2017 guidelines, counsel on condom use and safe sex in patients with proven genital herpes.
B

6.Preventative measures

Condom use: advise using condoms to reduce the risk of genital herpes transmission.
B

More topics in this section

  • Suppressive therapy