There are two strains of the herpes simplex virus (HSV) in humans: HSV-1 and HSV-2. Whilst it was previously thought HSV-1 accounted for oral lesions (cold sores) and HSV-2 for genital herpes it is now known there is considerable overlap

Features

• painful genital ulceration
  • may be associated with dysuria and pruritus
• the primary infection is often more severe than recurrent episodes
  • systemic features such as headache, fever and malaise are more common in primary episodes
• tender inguinal lymphadenopathy
• urinary retention may occur

Investigations

• nucleic acid amplification tests (NAAT) is the investigation of choice in genital herpes and are now considered superior to viral culture
• HSV serology may be useful in certain situations such as recurrent genital ulceration of unknown cause

Management

• general measures include:
  • saline bathing
  • analgesia
  • topical anaesthetic agents e.g. lidocaine
• oral aciclovir
  • some patients with frequent exacerbations may benefit from longer-term aciclovir

Pregnancy

• elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
• women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low

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Recurrent herpes outbreaks in pregnancy should be treated with suppressive therapy; risk of transmission to the baby is low and aciclovir is safe to use in pregnant women

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