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Herpes Genitalis

Herpes Genitalis or genital herpes is a STD (Sexually transmitted disease) that is caused by HSV(herpes simplex virus), either HSV1 or HSV2. This disease is taking on increasing proportions. Typically Herpes Genitalis spreads through sexual contact, either vaginal, oral or anal. Kissing and skin contact can also lead to the spread of genital herpes. Genital herpes passes through open sores and wounds. A person infected with herpes genitalis is likely to remain infected throughout his/her life. Most persons suffer recurrent episodes.


Genital herpes leads to painful sores on or around the genital area. There may be itching around these blisters. Men suffering from genital herpes notice sores on the shaft and head of the penis. There may be pain on urination. Women may suffer blisters on the vagina, cervix or inner thighs and develop vaginal discharge. Other symptoms of genital herpes include headache, backache and fever. Herpes genitalis can spread from one part of the body to another.


Genital herpes has been linked to instances of cervical cancer and genital warts. Pregnant women pass on this disease to the newborn. Virus culture of the fluid from the blisters is an indication of genital herpes. Oral medication such as acyclovir, famciclovir, penciclovir and valacyclovir are used in treating herpes genitalis. They are effective in suppressing the symptoms of genital herpes but not in curing the infection. Intravenous treatment is recommended for patients suffering from severe infection of herpes genitalis.


  • Wear loose-fitting cotton undergarments.
  • Ensure that you wash your hands thoroughly after cleaning the affected areas.
  • Keep the affected area clean and dry.
  • Lukewarm baths can give some relief.

Herpes Blood Test

Blood tests to diagnose the presence of herpes virus antibodies can be done even if the patient does not have any visible symptoms. The standard available tests are not recommended since they are not very accurate. There is a potential for false positive results. A type specific virus culture will give an accurate result only when the sores have not healed. Herpes Simplex Virus (HSV-1) and HSV-2 are the most common viruses diagnosed using type-specific blood tests. There are three methods available to diagnose herpes - Cell Culture, Antigen test and Pap Smear test.

Herpes Western Blot Test: A more sensitive test than the viral culture is the Gold Standard test known as PCR DNA test. This test also known as Herpes Western Blot test, which is rated as an accurate test to identify DNA for viral particles which easily differentiates the two types, viz. type-1 and type-2. This test can be carried out safely during pregnancy. A wide range of antibodies that respond against many herpes simplex virus proteins are tested in Western Blot test.

BIO-KIT or POCKit TEST: Recently, a more accurate POCKit type-specific test has been approved by FDA (Food and Drug Administration) to diagnose herpes simplex virus-2. A doctor's office can do this Point Of Care (POCKit) test and provide results in just 10 minutes. This new test is cost-effective and less time consuming. A positive HSV-2 test result confirms genital infection. Sensitivity in this test is around 96% accurate. Using this test during pregnancy is not approved by FDA.

ELISA ,Immunoblot and IgG type specific Elisa are the other three tests carried out to diagnose HSV-1 & HSV-2 types with the sensitivity ranging from 96% - 100%. Blood drawn from the patient's arm is sent to local labs and the results are available in a fortnight.


Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus  HZO, also known as Ocular Shingles, is a painful dermatomal rash around the eye region and forehead caused by the reactivation of the Varicella Zoster Virus (VZV). It affects the trigeminal nerve of the ophthalmic division and eventually spreads to the other structures of the eye. The first division of the trigeminal nerve is the most common site for the development of acute herpes zoster.


Varicella-zoster virus manifests at two different stages in humans. At primary level the virus causes chicken pox after which it remains dormant for several years and reappears as herpes zoster later in the patient’s life. Aging, poor nutrition and low immunity are some of the risk factors that leads to the outbreak of Herpes zoster ophthalmic us (HZO).


 

Symptoms

HZO begins with flu-like symptoms including fever, Myalgia, and malaise for nearly a week. Typically, patients then develop tingling sensation and painful rash on the forehead and ocular symptoms such as eyelid edema; conjunctival, episcleral and circumcorneal conjunctival hyperemia; corneal edema and light sensitivity. All these symptoms are unilateral - occurring on one side of the face. 


 

Diagnosis

Herpes zoster ophthalmicus (HZO) is diagnosed clinically by mere observation of the symptoms. During a clinical visit, the ophthalmologist conducts a detailed examination of  visual acuity, visual fields, extra ocular movements, pupillary response, corneal function, Intraocular Pressure and anterior chamber. Doctor also makes a note of past history of chicken pox infection along with clinical examination. Viral culture, direct immunofluorescence assay, or Polymerase chain reaction (PCR) may also be used to confirm the diagnosis. Any signs of Hutchinson disease strongly indicates ocular complications such as inflammation and corneal denervation and forms the basis for diagnosis of herpes zoster ophthalmicus.


 

Treatment

Herpes zoster ophthalmicus is a medical emergency and should be treated promptly to avoid vision loss. The disease leads to many ocular conditions such as dermatitis, corneal pseudo-dendrites, uveitis, retinitis, and in rare cases it also causes cranial nerve palsies. Oral anti viral medicines like Acyclovir and Famcyclovir play a major role in treating herpes zoster ophthalmicus. Atropine eye drops are also prescribed to alleviate the painful symptoms. In case keratitis develops, Corticosteroid drops along with Cycloplegics (eye drops to induce ciliary muscle paralysis) may also be considered.


 
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Bibliography / Reference

Collection of Pages - Last revised Date: December 13, 2019