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Genital, or venereal, herpes is a highly contagious viral infection of the male and female genitalia. Physical examination for evidence of the characteristic lesions is usually sufficient for diagnosis. Clients may be embarrassed about their disease; reassure them that they can lead a sexually healthy life so long as they adhere to proper precautions. No proven method of prevention among adults has been established other than avoiding sexual intercourse and other sexually intimate contact with infected individuals when lesions or symptoms of herpes are present and using condoms during all sexual exposure.
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All patients diagnosed with genital herpes should be told that recurrences can be prevented and offered oral antiviral therapy.
A key issue for many patients who have this disease is transmission, but there are currently insufficient data to make any firm recommendations for continuous antiviral therapy, based on the possibility that it may prevent transmission. Aciclovir was the first agent to be licensed for the treatment of herpesvirus infections, and has been the standard therapy for genital HSV infection for many years. Patients can be managed with episodic antiviral therapy which they can start themselves each time they detect the first signs of a recurrence. For recurrent episodes in pregnant women, antiviral treatment is not recommended or licensed. Neonatal HSV disease is a rare but serious condition, usually as a consequence of vertical transmission of the virus from the mother to the newborn child, although an estimated 10% of cases may be acquired postnatally from a parent, caretaker, or sibling. The risk of transmission is 30-57% in cases of primary infection acquisition by the mother in the third trimester of pregnancy. HSV-1 neonatal herpes is extremely rare in developing countries because primary exposure to HSV-1 (and therefore development of HSV-1 specific antibodies) usually occurs in childhood or adolescence, precluding a genital HSV-1 infection; HSV-2 infections are much more common in these countries.
In industrialized nations the adolescent HSV-1 seroprevalance has been dropping steadily for the last 5 decades as a result of better hygiene, less over-crowding, and smaller family size.
A recent three year study in Canada revealed neonatal HSV infections in 5.9 per 100,000 live births.
Untreated, SEM herpes may spread to the internal organs and cause DIS or CNS herpes resulting in increased mortality and morbidity. Death from neonatal HSV disease in the US is currently decreasing; as high as 85% of HSV infected neonates died a few decades ago whereas the current death rate is about 25%. SEM herpes is characterized by external lesions but no internal organ involvement, and has the best prognosis.
CNS herpes is an infection of the nervous system and the brain that can lead to encephalitis. Infants exposed to HSV during birth, as documented by maternal virologic testing or presumed by observation of maternal lesions, should be followed carefully in consultation with a pediatric infectious disease specialist.
Surveillance cultures of mucosal surfaces to detect HSV infection might be considered before the development of clinical signs of neonatal herpes. In addition, administration of acyclovir might be considered for infants born to women who acquired HSV near term because the risk for neonatal herpes is high for these infants.
All infants who have neonatal herpes should be promptly evaluated and treated with systemic acyclovir. Herpes simplex virus infection in the newborn "carries high mortality and morbidity rates from central nervous system involvement," according to Harrison's Principles of Internal Medicine, which recommends that pregnant women with active genital herpes lesions at the time of labor be delivered by cesarean section.

Herpes is a viral disease caused by both Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Herpes viruses cycle between periods of active diseasea€”presenting as blisters containing infectious virus particlesa€”that last 2a€“21 days, followed by a remission period. Herpes simplex is most easily transmitted by direct contact with a lesion or the body fluid of an infected individual. All material on this website is protected by copyright, Copyright © 2009-2016 by DermDiagnosis LLC. Scraping and biopsy of the ulceration with evidence of HSV-2 may be required to confirm the diagnosis.
The prognosis varies according to the individual’s age, the severity of the infection, the promptness of treatment, and the individual’s immunological response.
Transmission of the disease to neonates can be minimized through cesarean delivery when it is known that the mother is infected. Before patients begin therapy, whether it is episodic or suppressive (preventative), they need to have their own set of objectives for what they want to accomplish from therapy.
Those patients who have recurrences need to be given the information that recurrences and asymptomatic shedding can be prevented. However, aciclovir is limited by its low bioavailability and consequent frequent dosing regimens. Self initiation allows each recurrence to be treated more expeditiously than if a physician had to consulted. Risk of transmission by a mother with existing antibodies for both HSV-1 and HSV-2 has a much lower (1-3%) transmission rate. Infants with CNS herpes present with seizures, tremors, lethargy, and irritability, they feed poorly, have unstable temperatures, and their fontanelle (soft spot of the skull) may bulge.[3] CNS herpes is associated with highest morbidity, and DIS herpes has a higher mortality rate. Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Transmission may also occur through skin-to-skin contact during periods of asymptomatic shedding. Melanoma is the leading cause of cancer death of women in their 20s and second only behind breast cancer among women in their 30s? These drugs will not eradicate the virus, but when taken as soon as an outbreak occurs, they can shut down virus production.
It is estimated that as many as 80% of individuals with primary genital herpes infections will experience a recurrence within 12 months. Many patients ask about transmission when discussing suppressive therapy with their physician, but while there are scientific reasons to believe that reduction of asymptomatic shedding would probably correlate with reduced transmission risk, at the moment there are insufficient data to support or refute this hypothesis.
Newer antiviral agents, such as valaciclovir and famciclovir, have improved bioavailability and can offer less frequent dosing. Education directed at recognition of early signs and symptoms, including prodrome, is very important.
Oral herpes, the visible symptoms of which are colloquially called cold sores or fever blisters, infects the face and mouth. After initial infection, the viruses are transported along sensory nervesto the sensory nerve cell bodies, where they become latent and reside life-long. Barrier protection methods are the most reliable method of preventing transmission of herpes, but they merely reduce rather than eliminate risk.

Recurrent infections (outbreaks) may occur from time to time, especially in times of immune impairment such as HIV and cancer-related immune suppression. Herpes simplex type 2, or genital herpes, affects the genital area and is characterized by genial ulcers or sores. In more severe cases, antiviral medications such as Acyclovir, famcyclovir, or Valacyclovir can be prescribed to treat infections or lessen the symptoms. During the active stage, characteristic skin lesions and other accompanying symptoms may occur. The diffuse redness of the skin, or erythema, is caused by dilation of the superficial capillaries.
A topical cream made from the Prunella vulgaris plant has shown promise in reducing skin lesions. Allowing patients to self-initiate treatment without having to go back to a physician also returns control of the infection to the patient. However, it is an option to treat and a further option to continue to term with suppressive antiviral therapy, provided informed consent is obtained from the patient. Causes of recurrence are uncertain, though some potential triggers have been identified, including immunosuppressant drugs (see below).
However, after several years, some people will become perpetually asymptomatic and will no longer experience outbreaks, though they may still be contagious to others. Cross-infection of the two types through oral-genital contact can lead to genital herpes on your mouth. Early antiviral treatment can also significantly reduce the frequency and severity of future outbreaks. Infection typically occurs during sexual intercourse, oral-genital sexual activity, kissing, and handto-body contact. Treatments with antivirals can reduce viral shedding and alleviate the severity of symptomatic episodes. The incidence of genital herpes is beginning to decline, but at least 45 million individuals ages 12 and older have genital herpes.
A particularly life-threatening form of the disease can occur in infants infected by the virus during vaginal birth. Other generalized symptoms may include fever, headache, malaise, muscle pain, anorexia, and dysuria. Other disorders such as herpetic whitlow, herpes gladiatorum, ocular herpes (keratitis), cerebral herpes infection encephalitis, Mollaret's meningitis, neonatal herpes, and possibly Bell's palsy are all caused by herpes simplex viruses. It should not be confused with conditions caused by other viruses in the herpesviridae family such as herpes zoster, which is caused by varicella zoster virus.
The differential diagnosis includes hand, foot and mouth disease due to similar lesions on the skin.

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