STD Toolkit

Herpes

Symptoms:

Painful single or multiple vesicular or ulcerative lesions present in the genitals, buttocks or groin area of men or women, also:

Females
  • Itching, pain, swelling, burning or redness prior to lesions appearance, anywhere in the genital area, buttocks or groin.
  • Fever, chills, nausea, tiredness, muscle aches and headaches.
  • Dysuria - mild to very severe, depending on location of lesion(s).
  • An increase in discharge - usually very runny.
  • Swollen lymph nodes, usually inguinal and tender on palpation.
  • Complaints of shooting pain through the buttock, occasionally radiating down one or both legs.
  • Complaints of pain at lesion(s), sometimes so severe client can barely stand the pressure of her undergarments.
  • History of recurrent lesions at or near the same sight.
  • Client states her partner is an HSV carrier.
Males
  • Complaints of itching, burning, tingling or redness several days before the onset of lesions anywhere in the genital area including the penis, scrotum, pubis, rectum, thighs or buttocks.
  • Possible fever, chills, aching, tiredness, and nausea.
  • Swollen inguinal lymph nodes - usually not as painful as the nodes of the female.
  • Complaints of pain at the site of lesions sometimes so tender that undergarments cause severe pain.
  • History of recurrent lesions at or near the same site.
  • Client states his partner is an HSV carrier.

Definitive Diagnosis:

Laboratory confirmed HSV-2 (identification of HSV in a genital lesion or genital secretions by culture, an approved immunochemical method, or PCR, AND/OR serology: only selected commercially available glycoprotein G-based type-specific serological tests (e.g., HerpeSelectTM, POCkitTM) or Western blot reliably differentiate HSV-2 from HSV-1 antibody)

Screening for the general population is not indicated. Consider testing patients if:

  • They have genital sores
  • They have a partner with genital herpes
  • They are seeking STD evaluation (especially if they have multiple sex partners)
  • They are infected with HIV
  • They are an MSM at increased risk for HIV acquisition
  • Viral Culture - within the first 48 hours after a lesion appears, higher false negative rate afterwards
  • HSV DNA PCR - swab symptomatic area; more sensitive than culture
Recommended, with reservations:
  • IgG - 12-16 weeks from last exposure
Not Recommended:
  • IgM
  • Test kits are available through referral laboratories. Testing/test kit availability may vary by laboratory.

First Clinical Episode

Begin treatment within 6 days of prodrome with one of the following:

Valacyclovir- (Valtrex) 1 gram. #20. One tablet 2 times daily for 10 days

Famciclovir- (Famvir) 250 mg. #21. One tablet 3 times daily for 7 days

Acyclovir 400 mg #30 One tablet 3 times daily for 10 days

Acyclovir 200 mg one tablet 5 times daily for 7-10 days

Recurrent (Episodic) Episode

Begin treatment at prodome or within 1 day of onset of lesions with one of the following:

Valacyclovir (Valtrex) - 500mg. #6. One tablet twice a day for three days.

Valacyclovir (Valtrex) 1 gm - #5. One tablet every day for 5 days.

Famciclovir- (Famvir) 1 gm. #2. One tablet twice daily for one day.

Acyclovir - 400 mg #15. One tablet 3 times daily for 5 days

Suppressive Therapy

Provide herpes suppressive therapy to anyone with a valid history or lab diagnosis of herpes for one year. Re-evaluate annually.

Valacyclovir (Valtrex) 500 mg. #30 tablets. One tablet P.O. daily for 30-90 days with 4-11 refills by prescription.

Famciclovir (Famvir) 250 mg. #60 tablets. One tablet P.O. twice daily for 30-90 days with 4-11 refills by prescription.

Acyclovir 400 mg #60 tablets. One tablet P.O. twice daily for 30- 90 days with 4 -11 refills by prescription.

For more information on HSV treatment options, see CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015.

Perineal herpes lesions
Perineal herpes lesions
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Labial herpes lesions
Penile herpes lesions
Penile herpes lesions