At a Glance - Genital herpes zoster vs herpes simplex

Dr Jean Watkins discusses the differences between genital herpes zoster and herpes simplex

Herpes zoster presents with a rash
Herpes zoster presents with a rash

Genital herpes zoster

Aetiology

  • After chickenpox, the herpes zoster virus lies dormant in a sensory nerve ganglion.
  • If reactivated later, shingles presents in the affected dermatome.
  • More common in the elderly, immunosupressed and those with haematological malignancies.

Presentation

  • Unilateral pain (often severe) and itching in perineal area. May have fever.
  • A few days later, unilateral vesicular rash develops in the region of the affected nerve.
  • Dries, crusts and heals over the following few weeks.
  • Pain may persist for months, especially in the elderly (post herpetic neuralgia).
  • Risk of secondary infection and dysuria.

Management

  • Usually clinical diagnosis but viral swab can be taken for confirmation.
  • Antiviral therapy recommended for the over-sixties or if immunosupressed.
  • Treatment is aciclovir 800mg five times daily for seven days. More effective if started within 72 hours of rash onset.
  • Topical calamine lotion or wet dressings with 5% aluminium acetate.
  • Topical lidocaine for painful urination.
  • Analgesics for pain. If necessary add amitriptyline, gabapentin or topical capsaicin.

Herpes simplex presents with small painful blisters

Genital herpes simplex

Aetiology

  • Caused by the herpes simplex virus, usually type-2.
  • Usually sexually transmitted.
  • Following initial infection, the virus lies dormant but may reactivate.

Presentation

  • Itching, tingling and burning in the perineal area.
  • Groups of small painful blisters develop on the labia, vagina or cervix.
  • Risk of secondary infection, dysuria and retention of urine.
  • Risks in pregnancy include microcephaly, microphthalmia, intracranial calcifications or chorioretinitis.

Management

  • Diagnosis may be confirmed by viral swab of blister fluid.
  • Topical treatment as for herpes zoster.
  • Early treatment with an antiviral (aciclovir 200mg five times daily for five days) may settle the condition quicker.
  • Prophylactic antiviral therapy for frequent recurrences for up to six to 12 months.

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