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Infections and Inflammation of the Genital Tract



A. Etiology

1. Herpes simplex hominis, all enveloped DNA virus

2. virus is usually transmitted sexually

3. Incubation 2-20 days; average 6 days

B, Incidence

1. It is the most common cause of vulvar ulcers, second only to gonorrhea as a reason for patients' visits to sexually transmitted disease (STD) clinics

2. virus type II antibodies have been found in 20% of control patients and 100% of prostitutes

3. Number of cases that occur annually: 500,000

4. Approximately 25 million cases in the United States

C. Signs and symptoms

I. Sudden onset of painful erythema and swelling of the vulva

2. Purulent, odorous discharge

3. Followed by diffuse swelling and clear vesicles

4. Later, the vesicles break, and there is ulcer formation. With an initial infection, lesions last 15-21 days and vital shedding 8-10.4 days

5. Cystitis. dysuria, and urinary retention may be associated

The recommendations in this outline do not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice important to consider variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice tha: may be appropriate

6. Malaise, myalgia, and low grade fever sometimes occur

7. Many subclinical cases occur

D. Diagnosis

1. Inspection of vulva, vagina, and cervix

2. Routine pap smear of lesion and/or cervix; will detect 60-80 %; cytologic changes

a. Glassy, degenerated appearance of the nuclei

b. Acidophilic nuclear inclusions (cowdy type A)

c. Less commonly, multinuclear giant cell with either balloon

3. Biopsy of the lesion

4. Culture of the lesion

5. A four-fold increase in antibodies may be helpful

E. Treatment

F. Recurrentent HSV genitalis


A. Etiology