Dermatology - Genital Herpes Simplex Virus Infection
A persistent sexually transmitted virus condition called genital herpes is characterized by both symptomatic and silent viral shedding. This is a chronic infection that becomes worse with aging and comes back. Meningitis and radiation injury are prevented by treating the first episode infection. Erythema multiforme, which appears 1-2 weeks following an epidemic, can exacerbate recurrences. Many people who are infected are unaware that they are infected. When symptomatic, the following symptoms may be present: considerable pain, regional lymphadenopathy, fever, headache, malaise, and myalgia, which peak in the first 2-4 days following the beginning of lesions and resolve in the following 2-4 days. Prior to skin eruption, recurrences may present with itching, burning, fissures, redness, irritation, dysuria, sciatica, and rectal discomfort. The majority of clinical lesions appear as erosion, "abrasions," or fissures and are actually small breaches in the mucocutaneous epithelium. Erythematous papules that develop into vesicles or pustules are the typical lesion; they eventually erode as the underlying epidermis sloughs off. In 2-4 weeks, lesions resolve; scarring is rare and postinflammatory hypo- or hyperpigmentation is typical. Lesions in patients with impaired immune systems typically have larger areas and take longer to heal. Recurrence lesions are similar, but smaller in size, and they recover in a couple of weeks. Viral culture is used to confirm the diagnosis, and serology, direct fluorescent antibody (DFA), or both may be necessary. Make sure there is no co-infection with any other STDs. The differential diagnosis consists of gonococcal erosion, trauma, candidiasis, syphilitic chancre, eruption from a fixed medication, and chancroid. Encourage patients to abstain from sexual activity if they have lesions and to use condoms while having sex. Acyclovir 400 mg should be taken five times a day for ten days or until the lesions clear up for the first episode; for recurrences, use 400 mg three times a day for five days or 800 mg three times a day for two days. Famaciclovir 125 mg twice daily for five days or 1 g once daily for five days are the alternative options for valacyclovir 500 mg twice daily for seven days or 1000 mg twice daily for five days. Acyclovir 400 mg twice a day, valcyclovir 500–1000 mg once a day, or famciclovir 250 mg once a day should be administered for suppressive therapy. If you are seriously immunocompromised, have acyclovir or foscarnet intravenously.
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