Genital Herpes Simplex (HSV)
Genital herpes is a common, recurrent viral infection usually caused by HSV-2, though HSV-1 (traditionally oral) is an increasingly common cause of genital infection due to changes in sexual behavior.
Clinical Presentation
- Primary Episode: Often severe. Presents with systemic symptoms (fever, malaise, myalgias) and painful, grouped vesicles on an erythematous base that ulcerate.
- Recurrent Episodes: Usually milder, shorter duration, and often localized; heralded by a prodrome of burning or tingling.
- Location: Vulva, vagina, cervix, penis, scrotum, and perianal region.
Diagnostic Approach
| Method | Utility |
|---|---|
| PCR | Gold standard; highly sensitive and specific; can type HSV-1 vs. HSV-2. |
| Viral Culture | Specific, but lower sensitivity; requires active lesion. |
| Tzanck Smear | Shows multinucleated giant cells; historical significance but low sensitivity. |
High-Yield Exam Pearl:
- Management: Oral antivirals (Acyclovir, Valacyclovir, Famciclovir) for primary infection and recurrences. Chronic suppressive therapy is indicated for patients with frequent recurrences.
- Pregnancy: Requires special management to prevent neonatal transmission; if active lesions are present at time of delivery, Cesarean section is mandatory.