Herpes Simplex in Emergency Medicine Follow-up

Updated: Jun 26, 2017
  • Author: Melissa Kohn, MD, MS, FACEP, EMT-T/PHP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Follow-up

Further Outpatient Care

Oral medication (see Medication): Topical acyclovir is only minimally helpful in patients with primary disease and is probably ineffective in recurrent episodes.

Burroughs Wellcome Co maintains a registry for monitoring outcome in pregnant women exposed to acyclovir; physicians should register patients at (800) 722-9292, extension 58465.

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Further Inpatient Care

Admission for patients with herpes simplex is necessary in the following instances:

  • Encephalitis, hepatitis, or pneumonitis
  • Severe gingivostomatitis causing decreased ability to tolerate oral fluids
  • Immunocompromised patients with severe or disseminated disease
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Deterrence/Prevention

HSV-2 is an STD. Patients and all sexual contacts should be tested and treated for accompanying STDs.

Practice abstinence when lesions are present.

Always use condoms because of the potential for asymptomatic viral shedding.

Health care personnel (especially medical, dental) should use universal precautions (eg, gloves) to prevent herpetic whitlow.

Experimental vaccines are currently in clinical trials.

Use sunscreen to decrease herpes labialis recurrences.

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Complications

Encephalitis: Rare complication of herpetic infection; commonly HSV-1 (hypothesized to spread to the brain via neural routes after primary or recurrent infection)

Neonatal infections: Range from mild localized infection to a fatal disseminated disease; HSV-2 usually spread via the maternal genital tract; congenital infections possible

Compromised host: Progressive and disseminated disease possible

Genital infection: Acute urinary retention

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Prognosis

Genital HSV-2 infection has a high recurrence rate. More than 85% of patients with one symptomatic episode will experience another. Recurrences may be frequent; 38% of the population with genital herpes have more than 6 recurrences per year; 20% have more than 10 recurrences per year.

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Patient Education

Antiviral therapy may decrease the clinical manifestations of the disease but does not cure it.

Initiate antiviral therapy as soon as possible after the patient notices symptoms.

Consider prophylaxis for patients who have more than 6 recurrences per year.

Educate patient that HSV-2 is an STD. Follow deterrence measures. Encourage evaluation of sexual partners.

Referral to support groups: The American Social Health Association (ASHA) operates the National Herpes Hotline (919-361-8488), which provides educational materials and counseling for patients.

For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center and Teeth and Mouth Center. Also, see eMedicine's patient education articles Genital Herpes and Oral Herpes.

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