0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
Herpes Type 1/Type 2 705➣malaise
➣itching
➣dysuria
➣vaginal/urethral discharge
➣genital and/or anorectal pain
➣some asymptomatic (get numbers)
■Recurrent episodes;
➣∼50% of patients will have prodrome of:
genital or rectal itching
tingling
paintests
Genital Herpes
■Often clinical diagnosis
➣Culture lesion – easy to isolate
➣DFA/Tzank smear of lesion – quick, often available
➣HSV-1 vs. HSV-2
➣Antibodies to gG develop late in course – 3–6 months. Routine
serology does not distinguish HSV 1 vs. HSV 2.
➣Type specific serology: type-specific protein gG can differentiate
Oral Herpes
■Often clinical diagnosis
➣Culture lesion
➣DFA/Tzank
Encephalitis
■Virus isolation low yield
■Spinal fluid PCR fairly sensitive
differential diagnosis
n/amanagement
Condoms and daily suppressive therapy decrease risk of genital herpes
transmission to a susceptible partner.
specific therapy
Several antiviral drugs widely available to treat oral, genital, ocular,
neonatal herpes, herpes encephalitis. These include:
■Acyclovir
■Valacyclovir – advantage: twice/day (vs. 5×day)
■Famciclovir – given 2–3×day, comparable to acyclovir for acute her-
pes, also used to suppress infections