Herpes Simplex Virus: A Practical Guide to Diagnosis, Management, and Patient Counseling for the Primary Care Clinician.

Genital herpes is a chronic, lifelong sexually transmitted viral infection, which can cause recurrent, self-limited genital ulcers. It is caused by herpes simplex virus (HSV) type 1 and type 2 viruses. Genital HSV infection is a very prevalent STI, which causes self-limited, recurrent genital ulcers. Treatment decreases duration of symptoms and signs and can be provided as episodic or suppressive therapy. Genital herpes can have a substantial impact during pregnancy and on sexual health in general. Counseling on natural history, transmission, treatment, and management of sexual partners is an integral part of management of genital herpes.

Twenty years of herpes simplex virus type 2 (HSV-2) research in low-income and middle-income countries: systematic evaluation of progress made in addressing WHO prioritiesfor research in HSV-2 epidemiology and diagnostics.

INTRODUCTION: Low-income and middle-income countries (LMICs) have a high burden of herpes simplex virus type 2 (HSV-2) infection, which has been strongly associated with HIV. In 2001, the WHO hosted a workshop to set research priorities for HSV-2 in LMICs. Periodic re-evaluation of research priorities is essential to ensure effective allocation of resources. This study describes the progress made between 2000 and 2020 in addressing the priorities identified in two of the five thematic areas that were the workshop's focus: HSV-2 epidemiology and diagnostics. The remaining areas are addressed in a companion paper. METHODS: A systematic search of MEDLINE, CINAHL, Global Health and Cochrane databases was carried out. Relevant primary and secondary research studies conducted in LMICs, written in English and published from 2000-2020 were included. Two independent researchers screened, identified papers and extracted preidentified variables from study texts. Data were organised into an Excel spreadsheet and analysed using IBM SPSS V.26. RESULTS: Overall, 4445 discrete papers were identified, of which 165 publications were eligible for inclusion. The highest general population HSV-2 prevalence was reported in South and West Africa. Prevalence was higher among women than men and increased with age. HSV-2 prevalence studies among key populations were few, and the majority were in East and South Asia. Cohort studies of HSV-2 incidence among younger populations (mean age=25 years) and HSV-2 infection prevalence in North Africa and the Middle East were few. The most researched topic in HSV-2 diagnostics addressed serological techniques and direct molecular biology. Studies of point-of-care testing were also few. CONCLUSION: HSV-2 research identified in LMICs has mainly addressed the epidemiology and diagnostics priorities identified by the 2001 WHO workshop. Unaddressed priorities include point-of-care testing, antiviral resistance and exploration of HSV-2 epidemiology in neglected geographical settings and population subgroups.

Sepsis and multi-organ failure due to genital herpes in a healthy person.

Herpes simplex virus type 2 (HSV-2) is highly prevalent in several regions of the world and is the main pathogen causing genital herpes, which is transmitted almost exclusively through sexual contact. Systemically disseminated infections caused by HSV-2 are rare and most often seen in newborns, pregnant women, or immunocompromised populations. The virus can invade multiple organs and cause damage. In this paper, we present an extremely rare case of an immunocompetent 36-year-old male who came to our hospital with a high fever with abdominal pain and died of sepsis and multiple organ dysfunction syndrome within a short period. After the exclusion of common pathogens such as bacterial and fungal infections during hospitalization, metagenomic next generation sequencing of the patient's peripheral blood and ascites gave us the answer, and very high nucleic acid sequence counts of HSV-2 were detected in both his peripheral blood and ascites, confirming HSV-2 as the causative virus. In addition, this paper provides a brief review of the relevant literature.

An unusual co-reactivation of herpes genitalis and shingles in a young male with primary genital herpes in partner.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcers in industrialized countries. Herpes zoster (HZ) is an acute, cutaneous viral infection caused by the reactivation of the varicella-zoster virus (VZV). CASE SUMMARY: A 27-year-old male presented with painful vesicles over the trunk for the last 5 days with painful genital erosions for the last 2 days. His spouse also developed painful genital erosions with systemic complaints for the last 2 days. VZV Polymerase Chain reaction (PCR) from trunk vesicles and type-specific anti-HSV antibody from serum were positive from the index case. DISCUSSION: Here, we report an unusual case of co-reactivation of herpes zoster and genitalis in an immunocompetent male. We recommend the use of molecular testing to confirm the diagnosis of VZV or HSV infection in all cases of genital herpes-like lesions to exclude multi-segmental herpes zoster.

Tumor-like herpes simplex infection in an HIV patient

Abstract A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.

Characteristics of genital herpes in Bilbao (Northern Spain): 12-year retrospective study / Características del herpes genital en Bilbao (Norte de España): estudio retrospectivo de 12 años

Introducción: El virus herpes simple tipo 2 (VHS-2) es la causa más frecuente de herpes genital (HG), pero la infección genital por el virus herpes simple tipo 1 (VHS-1) está en aumento. El objetivo del estudio fue analizar las características epidemiológicas de pacientes con HG. Métodos: Estudio retrospectivo desde enero del 2004 hasta diciembre del 2015 de pacientes con HG atendidos en 2 consultas de enfermedades de transmisión sexual (ETS) en la Organización Sanitaria Integrada Bilbao-Basurto, en el norte de España. Se revisaron y analizaron los datos de interés de los pacientes. Resultados: Mil tres pacientes (524 hombres y 479 mujeres) fueron incluidos. El 74% tenía infección por VHS-2. El VHS-1 aumentó durante el periodo estudiado, significativamente en hombres (28% en 2004-2007 vs. 50% en 2012-2015). El VHS-1 fue mayor en mujeres en comparación con hombres (56% vs. 44%). La infección primaria fue más frecuente en los infectados con VHS-1 comparado con VHS-2 (79% vs. 21%). En pacientes con VHS-1, la infección primaria fue superior en hombres (86%) y en menores de 30 años. El 63% de las infecciones por VHS-2 fueron recurrencias. En el análisis multivariante, la edad, el origen extranjero, la recurrencia, el contacto previo con HG de la pareja sexual, la infección previa por Neisseria gonorrhoeae y la prostitución se asociaron con mayor riesgo de infección por VHS-2. Conclusiones:El VHS-2 fue la causa principal del HG, pero la proporción de VHS-1 aumentó. El antecedente de ETS y las conductas sexuales de riesgo fueron predominantes en los pacientes con HG por VHS-2.(AU)

Background: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes (GH), but genital infection by herpes simplex virus type 1 (HSV-1) is increasing. The aim of this study was to analyze and compare epidemiological characteristics of patients with GH. Methods:Retrospective study conducted from January 2004 to December 2015 in patients with GH attended at two Sexually Transmitted Diseases (STDs) medical consultation of Bilbao-Basurto Integrated Health Organisation in Northern Spain. Patient's medical history was reviewed and data of interest was analyzed. Results: One thousand three patients (524 male and 479 female) were reviewed. HSV-2 was detected in 74%. The proportion of HSV-1 increased during the study period, significantly in men (28% in 2004–2007 vs. 50% in 2012–2015). More female than male had HSV-1 infection (56% vs. 44%). The proportion of primary infection was higher among HSV-1 compared to HSV-2 (79% vs. 21%). Among the patients with HSV-1, primary infection was higher among men (86%) and in younger than 30 years. Recurrent GH was higher among HSV-2 infections (63%). In a multivariate model older age, geographic origin outside Spain, recurrent infection, prior contact with a partner's genital herpetic lesions, previous N. gonorrhoeae infection and prostitution were significantly associated with HSV-2 infection. Conclusions: HSV-2 was the most common causative agent of GH, but the proportion of HSV-1 increased. Overall, antecedent of STD and sexual risk behaviors were more frequent in patients with genital HSV-2 infection.(AU)

Úlceras genitales por virus herpes simplex / Genital ulcers caused by herpes simplex virus

El herpes genital es una enfermedad de transmisión sexual causada por los virus herpes simplex tipo 1 (VHS-1) y tipo 2 (VHS-2), pertenecientes, junto al virus varicela zoster, a la familia alfaherpesviridae. La lesión por VHS continúa siendo la causa más frecuente de úlcera vulvar entre la población sexualmente activa, y su incidencia aumenta cada año. En esta revisión resumiremos la microbiología del virus, la patogenia y la infección en genitales, las manifestaciones clínicas para su correcta identificación, las diferentes técnicas diagnósticas de laboratorio y la elección del correcto tratamiento según sea primera infección, recurrencia o casos especiales. Finalmente, se discute un análisis de costes de la enfermedad por VHS

Genital herpes is a sexually transmitted disease caused by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) belonging to the alphaherpesvirus family, that includes the varicella zoster virus. HSV infection continues to be the most common cause of vulvar ulcers among the sexually active population. Its incidence increases every year. This review summarises the microbiology of the virus, pathogenesis and infection in genitalia, clinical manifestations and correct identification, the different laboratory diagnostic methods, and choice of the correct treatment according to the first infection, recurrence or special cases. Finally, the cost of routine herpes simplex virus infection is analysed

Vegetative chronic genital herpes with satisfactory response to imiquimod

Abstract Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.

Tumefacción en región inguinal en varón VIH positivo / Tumefaction in the inguinal region in an HIV-positive male

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Herpes simple tipo 2: ¿en peligro de extinción? / Is Herpes Simplex Virus Type 2 in Danger of Extinction?

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Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo / Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study

INTRODUCCIÓN Y OBJETIVO: Se ha constatado un cambio en la epidemiología del herpes genital en los últimos años con un aumento de la incidencia del virus herpes (VHS) tipo 1. El objetivo de nuestro estudio es analizar las características clínico-epidemiológicas de los pacientes diagnosticados de un herpes genital. MATERIAL Y MÉTODOS: Se diseñó un estudio observacional retrospectivo donde se incluyeron todos los pacientes diagnosticados de herpes genital entre enero de 2016 y enero de 2019 en una Unidad de Infecciones de Transmisión Sexual (ITS) en Valencia, España. RESULTADOS: Se diagnosticaron 895 ITS, de las cuales 126 fueron un herpes genital (14%), 68 (54%) en mujeres y 58 (46%) en hombres. En 110 de ellos (87,3%) se confirmó el herpes genital por la detección de ADN viral por técnicas moleculares. Se diagnosticaron 52 casos de VHS tipo 1 (47,3%) y 58 casos de VHS tipo 2 (52,7%). En el 69,5% de los hombres se detectó el VHS tipo 2, mientras que en el 59,3% de las mujeres se detectó el VHS tipo 1. La edad media de las mujeres diagnosticadas de VHS tipo 1 fue de 26 años, mientras que la de las mujeres diagnosticadas de VHS tipo 2 fue de 34 años (p = 0,015). Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 fue del 13% y del 40%, respectivamente. CONCLUSIÓN: Destacamos un aumento de la prevalencia del VHS tipo 1 en nuestro medio como agente causante de herpes genital, especialmente en mujeres jóvenes. Esto tiene un valor pronóstico importante dado el menor riesgo de recurrencias que tiene

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur

Atuação do enfermeiro no diagnóstico e no tratamento do herpes genital, na atenção primária à saúde / The nurse's role in the diagnosis and treatment of genital herpes in primary health care

O Herpes Genital é uma Doença Sexualmente Trans- missível (DST), que acomete milhares de pessoas, sendo considerada um problema de saúde pública, no Brasil. A Abordagem Sindrômica é uma ferramenta importan- te para a realização do diagnóstico precoce e tratamen- to, sendo utilizada pelo enfermeiro, durante a Consulta de Enfermagem, na Atenção Primária à Saúde (APS). Os objetivos foram destacar a atuação do enfermeiro no diag- nóstico e no tratamento do Herpes Genital, enfatizar o uso da Abordagem Sindrômica e destacar a importância da Consulta de Enfermagem para a aplicação dessa Abor- dagem. Trata-se de uma pesquisa de revisão bibliográfica. Concluiu-se que interromper a cadeia de transmissão, as- sim como desenvolver estratégias de prevenção, tratamen- to e aconselhamento é essencial no acompanhamento do portador do Herpes Genital.

Genital herpes is a sexually transmitted disease (STD) that afflicts thousands of people, and is considered a public health problem in Brazil. The syndromic approach is an important tool for conducting early diagnosis and treatment, being used by the nurse during nursing consultation in Primary Health Care (PHC). The objectives were to highlight the nurse's role in the diagnosis and treatment of genital herpes, emphasize the use of the syndromic approach, and highlight the importance of nursing consultation for the application of this approach. This study is a literature review. It concludes that interrupting the chain of transmission, as well as developing strategies for prevention, treatment, and counseling is essential in monitoring the patient with genital herpes.

Prevalence of hrrpes simplex virus type 2 and rsk factors associated with thiss infection in women in southern Brazil / Prevalencia do herpes virus tipo 2 e fatores de risco associados a sua infeccao em mulheres do sul do Brasil

SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2. .

RESUMO O vírus herpes simplex tipo 2 (HVS-2) é uma das infecções mais prevalentes em todo o mundo. Considera-se um co-factor na aquisição do vírus da imunodeficiência humana (HIV) e na persistência do papilomavirus humano (HPV). Este estudo tem como objetivo avaliar a prevalência de HSV-2 usando a reação em cadeia da polimerase (PCR) e fatores associados em pacientes atendidos na Universidade Federal do Rio Grande e em Unidades Básicas de Saúde (UBS) do Rio Grande, Brasil. A prevalência de HSV-2 encontrada neste estudo foi de 15,6%. Entre as 302 mulheres estudadas, 158 haviam recebido assistência na UBS e 144 foram atendidos na FURG. A prevalência de HSV-2 nestes grupos foi de 10,8 e 20,8%, respectivamente, com RR: 1,9 e p = 0,012. Conhecer o exame de Papanicolaou, e presença de lesão não teve associação com infecção HSV-2. A análise multivariada mostrou que a variável que influencia no risco de infecção HSV-2 foi o paciente ter HIV, com risco relativo 1,9 e p = 0,04. Discussão: As úlceras genitais são importante porta de entrada para o vírus HIV e o uso do preservativo é estratégia importante para reduzir a transmissão do HIV e do HSV-2. .

Ulcerative nodules on the perineum / Nódulos ulcerados perianales

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Herpes genital / Genital Herpes

El Herpes genital es una infección de transmisión sexual vírica que representa la causa más frecuente de úlcera genital en nuestro medio. Clínicamente, cursa con episodios recurrentes que pueden ser asintomáticos o con lesiones características vesículas-úlceras. Aunque existen pruebas serológicas que confirman el diagnóstico, así como el cultivo viral de las lesiones, en Atención Primaria el diagnóstico es eminentemente clínico. El tratamiento de elección consiste en fármacos antivirales sistémicos, que acortan el tiempo de eliminación del virus, aunque no evitan la recidiva. Es importante recordar su frecuente predisposición con otras infecciones de transmisión sexual y, en especial, con el VIH. Por ello, no debemos desaprovechar la ocasión para realizar su búsqueda. Presentamos el caso de un varón adulto de 36 años con lesiones características que acude a nuestra consulta (AU)

The genital herpes is an infection of viral sexual transmission that represents the most frequent reason of genital ulcer in our environment. Clinically it deals with recurrent episodes who can be asymptomatic or with typical injuries vesicles-ulcers. Though there are serologic tests that confirm the diagnosis, as well as viral culture of the injuries, at Primary Care the diagnosis is eminently clinical. The treatment of choice consists of antiviral systemic medicaments, wich they shorten the time of elimination of the virus though they do not avoid the recidivation. It is important to remember the frequent predisposition with other infections of sexual transmission especially with the HIV infection. So we must not fail to take advantage of the opportunity to do search it. We present a case of a 36 years old adult male with typical injuries that comes to our consultation (AU)

Herpes genital vulvar e uso tópico de uncaria tomentosa: relato de caso / Uncaria tomentosa and topical use in genital herpes in vulva: case report

Introdução: herpes genital é uma doença infectocontagiosa de transmissão sexual que acomete pessoas das mais diversas camadas sociais. Herpes genital está disseminado em todo o mundo e é uma causa frequente de lesões genitais dolorosas em homens e em mulheres. Objetivo e Métodos: descrever caso de mulher adulta com quadro clínico e citológico de primomanifestação de herpes genital vulvar, no qual foi usado, na lesão, gel com 50 mg/g de Uncaria tomentosa três vezes ao dia, durante 4 dias. Resultados: os sintomas de dor e ardor tiveram rápida remissão. Ainda na consulta, cerca de 25 minutos apósaplicação tópica do fitoterápico, a paciente relatou grande melhora do quadro doloroso genital. A evolução clínica foi satisfatória e após 6 dias a paciente, já sem lesão, informou ter tido coito vaginal sem incômodos. Conclusão: a aplicação tópica de gel de Uncaria tomentosa em primomanifestação de herpes genital vulvar foi bem tolerada, não apresentou efeitos colaterais e melhorou rápida e sensivelmente o quadro clínico da doença.

Introduction: genital herpes is a sexually transmitted infectious disease that affects people from many different social strata. Genital herpes is spreadb worldwide and is a frequent cause of painful genital sores in men and women. Objective and Methods: to describe the case of adult women with clinical and cytologic clinical picture of a vulvar initial outbreak of genital herpes in which the lesion was treated with Uncaria tomentosa gel 50 mg/g three times a day for four days. Results: the symptoms of pain and burning had rapid remission. During the consultation, about 25 minutes after topical application of theherbal medicine, the patient reported great improvement in genital pain. The clinical outcome was satisfactory and after six days the patient, whose lesion had already healed, reported having had vaginal intercourse without discomfort. Conclusion: application of Uncaria tomentosa topical gel in a vulvar initial outbreak of genital herpes was well tolerated, showed no side effects, and rapidly and significantly improved the clinical symptoms of disease.