Management of genital herpes.

Genital herpes affects over 30 million persons in the United States. Genital herpes has three distinct presenting syndromes, depending on the patient's immune status with regard to the herpes simplex virus. Current diagnostic strategy relies on clinical findings and the selective use of viral culture. Acyclovir is the drug of choice for the treatment of genital herpes. Drug resistance is an increasing problem, requiring the use of newer agents. Treatment of the immunocompromised patient is a special area of concern. In addition to the medical aspects in the treatment of genital herpes, psychosocial requirements should also be addressed.

Delirium in the elderly patient.

Delirium is characterized by a sudden deterioration in cognitive function and an inability to sustain attention. It is a medical emergency that occurs in more than 20 percent of hospitalized elderly patients. Misdiagnosis is common and contributes to high morbidity and mortality. Patients may present in hypoactive, hyperactive or mixed states. Frail elderly patients are at greatest risk of delirium, especially those with dementia and multiple medical problems. Clinical history, physical examination and laboratory testing determine the most likely etiologies, such as medications (especially drugs with anticholinergic potential), infections and electrolyte disturbances. Effective management requires prompt treatment of the underlying pathology and maintenance of a supportive environment. It is often necessary to control agitation and prevent the complications of immobility in elderly patients with delirium. Although the long-term prognosis is guarded in elderly patients with delirium, sound geriatric care and a high index of suspicion can minimize the impact of delirium.