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Signs herpes outbreak is coming

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What is Herpes Simplex Virus?Herpes Simplex Virus Type 2 is the usual causative virus for genital herpes. Clinical Presentation of Herpes Simplex Virus HSVAbout 50% of people with Herpes Simplex Virus (HSV) may not have any symptoms at all but they can still spread the virus to their partners.First episode of genital herpes can be divided into primary herpes and non-primary herpes infection. Treatment of Herpes Simplex VirusGeneral measures include cleaning the affected areas with normal saline and usage of oral or topical analgesics to control pain. Genital Herpes Simplex Virus in pregnancyTransmission of herpes to the neonates occurs when mother has symptomatic genital herpes during delivery. Follow up post herpes infectionPatients with herpes simplex virus should be educated on the disease, its transmission, treatment and also potential of recurrence. The majority of infections are caused by human herpesvirus 1 (herpesvirus 1, human) and less often by human herpesvirus 2 (herpesvirus 2, human).
Primary herpes refer to the group of people with no prior exposure to either Herpes Simplex Virus Type 1 or Type 2. If there is co-infection of bacteria origin, treatment should be commenced too.Antiviral medicine has been in the market since the 1980s. It will be more optimal if treatment is started within 2-3 days of the onset of the lesions. The risk of transmission to neonate is higher (30-50%) from a mother with primary genital herpes during pregnancy as compared to mothers who have recurrent herpes or virus shedding during phase without symptoms.
A person with herpes may spread the herpes virus to the partner even when they do not have symptom, this is known as asymptomatic shedding of virus.


Non-primary genital herpes refer to people who have their first episode of genital herpes however they have herpes simplex virus type1 or 2 infections at other body sites before.First episode of genital herpes is often severe, painful multiple grouped vesicles which will rupture into erosions and ulcer will occur over the genitalia area. If the mother has premature rupture of membranes, the risk of transmission to the neonate is about 10%.Anti-viral therapy like acyclovir, valacyclovir and famiciclovir are considered pregnancy category B drugs. Pathologically, the condition is marked by a hemorrhagic necrosis involving the medial and inferior temporal lobe and orbital regions of the frontal lobe. These drugs are useful to aid recovery of each herpes episodes however they do not eradicate the virus from the person. Hence they can be managed by general and supportive measures like cleansing with normal saline and analgesics. Women who are pregnant should inform their obstetricians early.Sexual partners of patients with herpes should be counseled together with their partners.
Other associated symptoms include painful urination (dysuria), genital discharge, fever, enlarged lymph nodes in the groin area and vague tingling, burning and itching sensation. Type 1 and 2 Herpes Simplex virus have type specific glycoproteins gG1 in HSV1 and gG2 in HSV2 which can be tested individually allowing typing of HSV. Specific therapy with antiviral medications may not always be necessary.For each episode of recurrence genital herpes, if antiviral treatment is necessary it should be started within 1 day of the attack.
In life threatening HSV infection, intravenous acyclovir is used.Acyclovir can be started when near term to reduce the rate of caesarean sections. Uncomplicated lesions will usually resolve in 2 to 4 weeks.Recurrent attacks are often less severe than the first episode. These tests are useful for diagnosis, screening of partners and detection of unrecognized infections.


Starting 6 weeks from delivery, weekly genital viral cultures are taken and tested for herpes.
Recurrences range from 5 to 10 attacks a year and they tend to occur more often in the first 2 years of infection. After treating for 9 to 12 months, stop the medications and observe if there is any recurrence. If positive, treatment is commenced.If genital herpes lesions are present at labor, prepare for caesarean section within 6 hours from membrane rupture. If recur then continue suppression therapy.Treatment regime for HIV patients with Herpes Simplex VirusHIV patients being immune-compromised are prone to herpes recurrence. Neonates should then be screened for HSV using cultures from the eyes, oral-pharynx and rectum area within 2 days from birth. Immunosuppression states like patients with diabetes, renal patients, HIV patients and patients on immunosuppressant drugs like steroid are more susceptible to recurrence of herpes.
If any of the culture is positive, treatment should be started immediately and baby should be closely monitored.If there are no genital herpes lesions present at labor, mother can proceed with vaginal delivery.



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