Incubation – 3-6 days
Prodrome – 12-24 hours local hypersensitivity / discomfort
Lesions – prepuce /shaft / glans / anal / labia / clitoris / introitus and vagina / cervix (genitalia, anal region, mouth or throat)
- multiple vesicles appear surrounded by erythema
- 24-72 hours vesicles rupture (painful, superficial ulcers) 1-3 weeks
- regional enlarged tender nodes up to 6 weeks
- female: urinary retention, resemble carcinoma cervix or asymptomatic
- relapse(s) – milder and resolve quicker (stress, fever, trauma, hormonal changes, UV light, ethanol)
Herpes simplex – pathophysiology
- large, pock-size (icosahedral) enveloped dsDNA, temperature labile virion with thymidine kinase
- HSV-I and HSV-II with ∼ 10% cross-over
- HSV-I: childhood-acquired
- HSV-II: acquired after sexual activity commences
- ≈ genital herpes
- can be disseminated HIV
Herpes simplex diagnosis – clinical
- Tzanck smear (hilar cell culture) → cytopathological effect: ballooning / rounding cells ≤ 14 days
- ELISA / IF – commercial (rapid diagnostic) kits using ulcer smear
- Serology
Neonatal infection has high morbidity and even mortality:
- high morbidity / mortality – especially late in pregnancy (as no time for maternal antibodies to develop and pass to foetus)
- pregnant woman → ? caesarean section
Herpes simplex – management
- symptomatic treatment
- sedatives
- analgesics
- acyclovir – if severe, recurrent, immunocompromised, neonatal, or ophthalmic involvement
- sexual abstinence with active lesions + counselling
- condoms
- other STIs may coexist