Transcript HERPES SIMPLEX VIRUS

Type 1 is responsible for most
nongenital infections
Type 2 HSV is recovered almost
exclusively from the genital tract
1-First episode primary infection Only a
third of newly acquired HSV-2 genital
infections are symptomatic
The typical incubation period of2 to 10
days may be followed by a "classic
presentation," characterized by a
papular eruption with itching or
tingling, which then becomes painful
and vesicular and inguinal
adenopathy may be severe
2.First episode nonprimary infection
HSV-2 is isolated from genital
secretions in women already
expressing serum HSV-I antibodies
are characterized by fewer
manifestations because of some
immunity
3-Reactivation disease (recurrent
infection)
These lesions generally are fewer in
number, are less tender, and shed
virus for shorter periods-2 to 5 days
Most primary and first-episode
infections in early pregnancy are
probably not associated with an
increased rate of spontaneous
abortion or stillbirth
late-pregnancy primary infection
may be associated with preterm
labor.
Infection of eye or mouth disease
35% of cases.
Central nervous system disease with
encephalitis 30%
Disseminated disease with
involvement of multiple major organs
is found in 25%
HSV tests available are either
virological or type-specific
serological tests.
Several serological assay systems are
available to detect antibody to HSV
glycoproteins Gl and G2
HerpeSelect ELISA, HerpeSelect
lmmunoblot, and the Captia HSV Type
Specific test kit
This is controversial, and there is no
clinical evidence that it may prevent
HSV transmission and neonatal
infection
The American College of
Obstetricians and Gynecologists
(2007a) does not recommend routine
HSV screening
Antiviral therapy with acyclovir,
famciclovir, or valacyclovir has been
used for treatment of first-episode
genital herpes in nonpregnant
Acyclovir appears to be safe for use in
pregnant women
(More than 700 neonates exposed
during the first trimester were
evaluated, and they had no increased
adverse effects )
primary outbreak during pregnancy----antiviral therapy Women with HIV
coinfection ----longer duration of thx
severe or disseminated HSV---intravenous acyclovir, 5 to10 mg/kg, every
8 hours for 2 to 7 days followed by oral
antiviral therapy to complete at least 10
days of total therapy
Acyclovir prophylaxis given from 36
weeks to delivery
A careful examination of the vulva,
vagina, and cervix should be
performed and suspicious lesions
cultured
Cesarean delivery is indicated
for women active genital lesions
or prodromal symptoms
Cesarean delivery is not
recommended for women with
a history of HSV infection but no
active disease at the time of
delivery.
There is no evidence
that external lesions
cause ascending fetal
infection with preterm
ruptured membranes
Women with active HSV may
breast feed if there are no
active HSV breast lesions.
Valacyclovir and acyclovir
may be used during breast
feeding as drug
concentrations in breast milk
are low.
HUMAN PAPILLOMAVIRUS
Human papillomavirus (HPV) has
become one of the most common
STDs with more than 30 types
High-risk HPV types 16 and 18 are
associated with dysplasia
Mucocutaneous external genital
warts are usually caused by HPV
types 6 and 11
For unknown reasons, genital warts
frequently increase in number and
size during pregnancy.
These lesions may sometimes grow
to fill the vagina or cover the
perineum, thus making vaginal
delivery or episiotomy difficult
There may be an incomplete
response to treatment during
pregnancy,but lesions commonly
improve or regress rapidly
following delivery.
eradication of warts during
pregnancy is not always
necessary.
There are several agents available,
but pregnancy limits their use
Trichloroacetic or bichloracetic
acid, 80- to 90-percent
solution,applied topically once a
week is an effective regimen for
external warts. Some prefer
cryotherapy, laser ablation, or
surgical excision
Podophyllin resin, podofilox
0.5-percent solution or gel,
imiquimod 5-percent cream,
and interferon therapy are not
recommended in pregnancy
Juvenile-onset recurrent
respiratory papillomatosis is
a rare, benign neoplasm of
the larynx.
It can cause hoarseness and
respiratory distress in
children and is often due to
HPV types 6 or 11.
Prolonged rupture of membranes
was associated with a twofold
increased risk, but risk was not
associated with the mode of
delivery.
The benefit of cesarean delivery to
decrease transmission risk is
unknown, and thus it is currently not
recommended solely to prevent
HPV transmission