Genital herpes infection in women

K Pavithran

 Department of Dermato-Venereology, Malabar Institute of Medical Sciences, Calicut - 673 016, India

Correspondence Address:
K Pavithran
Department of Dermato-Venereology, Malabar Institute of Medical Sciences, Calicut - 673 016
India

Herpes simplex virus type 2 infection occurring on the genitals of women continues to be a therapeutic challenge. Primary infection that manifests in severe form with multiple painful vesicles and erosions on the labia majora and minora is treated with oral acycloivir 200 mg 5 times daily for 7 days. Sitz bath in N. saline for 20 minutes each time for 4 to 5 times daily often relieves pain and cleans the area. If the crusts are adherent wet compresses with N. saline helps to remove the crusts. If sleep is disturbed due to pain, systemic analgesics and tranquilizers are also prescribed. When there is associated secondary infection with bacteria oral ampicillin and metronidazole (to treat anaerobic bacteria) also are given. For recurrent herpetic lesions of the genitals in women, oral acyclovir 200 mg 5 times daily for 5 days and topical acyclovir cream 5% for application 4 times daily are recommended. If there are more than 10 recurrences per year, suppressive therapy will be considered. In such cases oral acyclovir 400 mg bid is given for 6 to 12 months. Recently I have started giving acyclovir 800 mg daily for 2 consecutive days in a week for suppressive regime.

When a pregnant woman develops HSV infection of genitals especially if it is primary (first) infection, I explain to the patient the need for acyclovir treatment in spite of being pregnant and give it in a dose of 200mg 5 times daily for 7 days. A normal vaginal delivery is recommended unless there is recurrence of herpetic lesions at the time of delivery. In such circumstances an elective caesarean section and delivery of the baby is advised.

Herpetic lesions of the genitals often fail to respond to usual dose of acyclovir, if there is associated HIV infection. Such patients are given acyclovir 200 mg 5 times daily for 4-6 weeks.

In all cases of genital herpes infection blood VDRL test and screening test for HIV are also performed.

All newborns of mothers with genital herpes are examined to exclude cutaneous or systemic especially CNS, involvement. Barrier nursing of infected babies is a must.