herpesvirus-2

herpesvirus-2

Genital herpes, herpes simplex-2 A herpesvirus that is most commonly transmitted sexually–only 5% of venereal herpes is caused by HHV-1, and rare under age 15 and primarily affects the body below the waist, causing venereal, vulvovaginal, and penile herpetic ulcers; like HS1, HS2 resides in sensory ganglia near the site of infection and multiplies during episodic periods of impaired cellular immunity, resulting in recurrence; this may be caused by heat, cold, sunlight, UV radiation–ie, sunlight, hypersensitivity reactions, corticosteroids, physical or emotional stress; HHV-2 is more prevalent in multiply married, ♀, urban African Americans with lesser educations Prevalence HSV-2 is detectable in ±20%, US Herpes in pregnancy Early gestational infection may cause spontaneous abortion; products of late gestation infection suffer microcephaly, mental retardation, retinal dysplasia, hepatosplenomegaly; recurrence rate in subsequent pregnancies approaches 70%; HS-2 causes most neonatal herpes, infecting via the birth canal; the infants are healthy at birth and become symptomatic 1-4 wks post-partum; early neonatal herpes causes vesiculobullous lesions–absent in 20%, lethargy, irritability, hypotonia and loss of gag and sucking reflexes; late neonatal herpes may cause generalized seizures, jaundice, hypotension, DIC, acidosis, apnea, thrombocytopenia, shock Diagnosis LM to identify cellular changes–eg, on a Pap smear, ELISA linked to an amplification culture system, complement fixation, culture in fetal fibroblasts, fluorescent antibody against membrane antigen; RFLP analysis allows epidemiologic tracking of sources of infection Treatment Antivirals–eg, cytosine arabinoside-5-iodo-2'-deoxyuridine, adenine arabinoside-Acyclovir, trifluorothymidine–Trifluidin shorten duration of attack