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Tender inguinal and femoral lymph nodes may be present. Primary genital HSV-1 infection cannot be distinguished from HSV-2 infection on clinical examination alone, but requires laboratory testing. Subsequent recurrent episodes with established immunity are milder than the initial infection. Genital HSV-1 recurs much less frequently (0.

Although shedding is greatest in the first n i h to 12 months, it can continue for years (Schacker et al, 1998; Benedetti et n i h, 1999). Lesions heal in 5 to 10 days roche ran nike the absence of antiviral treatment. HSV recurrences decrease after the first year, although some spike in recurrences in HSV-2 even after 4 years of follow-up have been noted (Benedetti et al, 1999).

Recurrent Episodes Diagnosis and Testing for Herpes Simplex Virus A primary genital herpes infection with either HSV-1 or HSV-2 is more severe in the absence of preexisting HSV-1 immunity (Corey A definitive diagnosis of HSV subtype should be made both to confirm the diagnosis and to obtain important prognostic Figure 15-5.

Typical vesicular eruption n i h herpes simplex virus. Sexually transmitted diseases treatment guidelines, 2010. In patients with lesions, fluid can be obtained from the base of the genital lesion and sent for viral culture, HSV antigen detection, or PCR of HSV DNA (Rose et al, 2008; Nguyen et al, 2010).

N i h patients with no active lesions, serology must be usedthat is, testing for antibodies. Specific immunoglobulin G (IgG) testing for glycoprotein Roche ventana of HSV-1 or HSV-2 can distinguish the two types of HSV (Ashley, 2001).

Serology is recommended for confirmation of a clinical diagnosis of genital herpes in patients with recurrent genital symptoms, atypical lesions, or healing ulcers and negative viral cultures. Type-specific antibodies to herpesvirus can take from 2 weeks to 3 months to develop; thus in a person with newly acquired herpes, an initial negative serology followed by a positive test after 12 weeks confirms a new infection (CDC, 2010c).

Treatment (Table 15-5) Currently available medications to treat herpes do not eradicate the virus, but aim to reduce the signs and symptoms of infection and to prevent new lesions. Available drugs include acyclovir (intravenous only), valacyclovir, and famciclovir (CDC, 2010c).

Treatment for a first clinical episode should be started on clinical grounds before laboratory confirmation of diagnosis.

Treatment is usually 7 to 10 days but should be extended if lesions are not adequately healed (CDC, 2010c). Treatment of recurrent episodes reduces their severity and duration. Oral therapy within 24 hours of the n i h signs or symptoms of recurrence increases the chance of resolving a recurrence without lesions (Leone et al, 2002; Wald et al, 2002; Aoki et al, 2006). Patients with HIV can have prolonged or severe episodes of HSV infection, and HSV shedding is increased in HIVinfected persons.

Doses fire durations of medications are increased for suppression and treatment of episodic HSV infections in n i h with HIV (CDC, 2010c). Chancroid Chancroid is caused by the gram-negative bacterium H. Infection leads to anogenital ulceration and lymphadenitis with progression to bubo formation (Lewis and Ison, 2006).

The incubation period is 3 to 10 days, with the initial Figure 15-6. Chancroid with regional adenopathy. Circumcised men are at lower risk of being n i h with chancroid (Weiss et al, 2006).

The prevalence of chancroid has declined in the United States n i h, 2013), but chancroid is still endemic in other parts of the world such as Africa, Asia, Latin America, and parts n i h the Caribbean; a genital ulcer in a person with a history of travel to these areas should raise suspicion for chancroid (Lewis and N i h, 2006).

Chancroid, like genital herpes and syphilis, is a risk factor for transmission of HIV (Magro et al, 1996). A definitive diagnosis of chancroid requires culture on media not routinely available (Lockett et al, 1991).

There are no FDA-approved tests. The CDC suggests that a probable diagnosis of chancroid can be made if (1) the patient has one or more painful ulcers; n i h PART III Infections and Inflammation (2) no evidence of T.



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