Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

706 Herpes Type 1/Type 2

■Forscarnet – more toxicity than acyclovir, sometimes used for

acyclovir-resistant infections

■Trifluridine/Idoxuridine – ophthalmic solution for keratoconjunc-

tivitis

Penciclovir – cream for orolabial herpes

Consider suppressive therapy when frequent recurrences.

follow-up

n/a

complications and prognosis

Herpes Proctitis

■pain

■anal discharge

■tenesmus

■constipation

Central Nervous System

■usually involves focal area of brain – temporal lobe

■often with behavior changes and altered consciousness

■severe condition

■untreated – 70% mortality

Aseptic Meningitis

■common complication of primary genital herpes

■30% of females, 10% of males

■headache, fever, photophobia

■lymphocytic pleocytosis

Autonomic and Peripheral Neuropathies

■associated with rectal and less frequently genital infection

■transverse myelitis

■Bell’s Palsy may be associated with HSV-1 reactivation

Herpetic Whitlow

■Most HSV-1, occasionally HSV-2

➣Painful infection on finger

➣Cutaneous vesicle

➣May have fever

➣May have lymphadenitis; epitrochlear and axillary sites

Herpes Gladiatorum

■Cutaneous herpes in areas of close contact during wrestling