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Herpes Simplex Virus in Depth / Alynn Alexander, MD


– Herpes is a sexually
transmitted infection that we commonly see in
the out-patient setting. The most important thing to recognize is that it is self-limited. But importantly,
understanding the diagnosis and making sure that it’s
something that does not subsequently get transmitted
to other partners is important. Typically when we see patients
who have herpes simplex virus infection, they have
ulcerations of the genitals. It can be something that
can be very uncomfortable and painful but is treatable
with anti-viral medications. Chlamydia is an infection
that we see often in patients who have absolutely no symptoms. It’s more common in men to
actually be symptomatic. So in a man with a chlamydia
infection they will often have a purulent penile discharge and potentially painful urination. Herpes simplex virus
is not curable although it is possible to control
the symptoms with medication. And what I mean by that
is prophylactic therapy. So patients who experience
frequent outbreaks can often be treated with medications that help prevent them from
having frequent outbreaks. Additionally that same
medication is the medication that can be used to prevent
transmission to a patient who’s never been exposed
to the virus in the past. Herpes simplex virus does
not affect your ability to conceive, it doesn’t affect fertility. However we do prevent outbreaks
at the time of delivery and the main reason for that is for transmission issues to the baby. So we do give medication during pregnancy that helps to prevent
the outbreaks that occur at the end of the pregnancy. Because if a patient does
have an active outbreak at the end of a pregnancy,
then an abdominal delivery or cesarean section is
indicated and preferable over a vaginal delivery to help reduce the risk of transmission to the baby. Herpes simplex virus is not
something that’s curable. It is something that continues
to live in the nerve root of the infected skin area. However, we can prevent frequent
outbreaks with medication. And that same medication can also be used to prevent transmission to a partner who’s never been exposed to the virus. Herpes simplex virus is
controlled in the body through the body’s own immune system. So initially, when a patient is infected with herpes simplex virus the
symptoms can be very severe. And it’s not uncommon that
in the primary outbreak of herpes simplex virus,
the symptomatology is such that a patient feels very ill. They can have flu-like
symptoms, they can have swelling of their lymph nodes in the groin. All those symptoms tend to be
self limited and will resolve in seven to 10 days,
even without treatment. But subsequent to that,
patients can get episodes of recurrences that
tend to be less severe. The reason why they’re
less severe is because the immune system has
been exposed to the virus. The immune system develops
antibodies that then control viral replication and can help prevent the severity of the outbreak
in subsequent outbreaks. So even though the initial
outbreak may be very severe, the subsequent outbreaks
tend to be not as severe. Additionally, if a
patient has that diagnosis and the symptoms are recognized early in the course of the outbreak,
medication can be started immediately which will help decrease the length and severity of the outbreak.

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