Understanding Herpes

8/19/2019 Understanding Herpes

1/53

UNDERSTANDING HERPES

VIRUS INFECTIONS

Jerome M. Eder, MD

Assistant Cini!a Pro"essor o" O#stetri!s and

G$ne!oo%$ Da&id Ge""en S!'oo o" Medi!ine at UC(A

Medi!a Ad&isor (os An%ees HE(P Gro)*

Her*es Reso)r!e Center


2/53

Genita Her*es&ir)s In"e!tions+ U*datin% An

Od Disease For T'e Ne Mienni)m

-I

Prin!i*a earnin% o#/e!ti&es+

0. Re&ie 'er*es &ir)ses !a)sin% ')man disease1. Dis!)ss STDs and *o*)ations at ris2 "or in"e!tion

3. Assess !'an%in% *re&aen!e o" %enita 'er*es in"e!tions

4. Dis!)ss di""erentia dia%nosis o" %enita 'er*es

5. O)tine met'ods o" 'er*es &ir)s dete!tion and dia%nosis

6. Re&ie )se o" neer 'er*es seroo%i! assa$s


3/53

Genita Her*es&ir)s In"e!tions+ U*datin% An

Od Disease For T'e Ne Mienni)m

-II

7. Di""erentiate !ini!a 'er*es *resentations

8. Dis!)ss and des!ri#e %enita 'er*es disease re!)rren!es

9. Detai mana%ement o" %enita 'er*es in"e!tions

0:. Re&ie )se o" a**ro*riate anti&ira medi!ations

00. Understand e""e!ts o" 'er*es on emotions and reations'i*s

01. Dis!)ss t'e im*ortan!e o" 'er*es d)rin% *re%nan!$


4/53

Her*es Fami$ o" Vir)ses

; Her*es sim*e< &ir)s t$*e=0 -HHV=0

; Her*es sim*e< &ir)s t$*e=1 -HHV=1

; Vari!ea=>oster &ir)s -HHV=3; E*stein=?arr &ir)s -HHV=4

; C$tome%ao&ir)s -HHV=5

; H)man 'er*es&ir)s 6 -HHV=6 @Roseoa &ir)s

; H)man 'er*es&ir)s 7 -HHV=7

; H)man 'er*es&ir)s 8 -HHV=8 @Ba*osis Sar!oma

Asso!iated &ir)s


5/53

STD Fa!ts

0. T'e United States 'as t'e 'i%'est STD rate in t'e ind)striai>ed ord

1. STDs n)m#er more t'an 05.5 miion !ases $ear$

3. Adoes!ents -a%es 05=09 are dis*ro*ortionate$ a""e!ted

4. A**ro


6/53

Her*es Sim*e< Vir)ses

HSV=0 Most$ oroa#ia -!od sores, "e&er #isters

Retro%rade *ro%ression &ia "a!ia ner&e #ran!'es

(aten!$ it'in %eni!)ate %an%ion -%an%ia

C)rrent$ re*orted to !a)se 3:=6: o" *rimar$ %enita 'er*es in"e!tions

HSV=1 Amost entire$ %enita ora in"e!tion rare

(aten!$ it'in sa!ra root %an%ia

Ca)ses K95 o" re!)rrent %enita 'er*es

Fre)en!$ o" as$m*tomati! &ira s'eddin%

Core$ (, Lad A. Genita 'er*es. In+ Homes B, S*arin% P, Mard' P, et a,

eds.Se


7/53

Fa!tors Asso!iated Lit' In!reasin%

Pre&aen!e o" HSV=1; Patients are not *rom*t$ or a!!)rate$ dia%nosed

; C'roni! !arriers are not identi"ied

; As$m*tomati! &ira s'eddin% -s)#!ini!a &irarea!ti&ation is )ndera**re!iated

; Medi!a t'era*$ is )nder)sed

; A**ro*riate !are or !o)nsein% o"ten )na&aia#e

; No !)re $et e


8/53

Genita Her*es as an Emer%in% Disease

0. Sin!e 0983 t'ere 'a&e #een a**ro


9/53

Estimated Ann)a Ne Cases o" STDs in t'e

United States

0. H)man *a*ioma&ir)s 5.5 miion

1. Tri!'omoniasis 5 miion

3. C'am$dia 3 miion4. Genita 'er*es 0 miion

5. Gonorr'ea 65:,:::

Baiser Fami$ Fo)ndation and Ameri!an So!ia Heat' Asso!iation s)r&e$s and *)#i!ations


10/53

Pre&aen!e o" Genita Her*es In"e!tions

NHANES II -0976=098:, mid*oint 0978

O&era sero*re&aen!e 06.4

Men 03.1

Lomen 09.4

NHANES III -0988=0994, mid*oint 0990

O&era sero*re&aen!e 10.7

Men 07.8

Lomen 15.6

@De*i!ts a 3: in!rease in sero*re&aen!e

@Des!ri#es a 5 in!rease in Ca)!asian teena%ers

@On$ 0: des!ri#ed de"inite 'er*es s$m*toms

Nationa Instit)tes "or Heat' Nationa Center "or Heat' Statisti!s


11/53

Nationa Pre&aen!e o" Genita Her*es

; Tota !ases = 5: miion -6: miion

; Re*resents 7 o" a ne !ases o" STDs

; Un2non n)m#er o" indi&id)as in"e!ted it' HSV=0%enita 'er*es

Ameri!an So!ia Heat' Asso!iation


12/53

Mana%in% Her*es+ Genita Her*es is

Underdia%nosedPersons it' HSV=1 re*ortin% de"initi&e !ini!a s$m*toms+

; NHANES III st)d$ -United States 9

; UB ?ood donors 07

; US -Seatte "ami$ *ra!ti!e 16

; US -Seatte STD !ini! omen 34

; UB STD !ini! 31

Femin% DT, M!Q)ian GM, Jo'nson RE, et a. Her*es sim*e< &ir)s t$*e 1 in t'e United States,

0976 to 0994. N En% J Med 0997337-06+00:5=00

As'e$ R, Lad A. Genita 'er*es+ re&ie o" t'e e*idemi! and *otentia )se o" t$*e=s*e!i"i!

seroo%$. Cin Mi!ro#io Re& 099901+0=8


13/53

Di""erentia Dia%nosis o" Genita Her*es

In"e!tio)s Nonin"e!tio)s

= S$*'iis = Cro'ns disease

= C'an!roid = ?e'!ets s$ndrome

= (GV = Tra)ma= Gran)oma in%)inae = Conta!t dermatitis

= S!a#ies = Er$t'ema m)ti"orme

= Candidiasis = Reiters s$ndrome

=Mo)s!)m !onta%ios)m = Psoriasis= (i!'en *an)s

As'e$ R, Lad A. Genita 'er*es+ Re&ie o" t'e e*idemi! and *otentia )se o" t$*e

s*e!i"i! seroo%$. Cin Mi!ro#io Re& 099901+0=8


14/53

L'at Lomen Sa$ T'e$ T'in2 T'e$ Ha&e+

=east in"e!tion =Aer%$ to=

=Va%initis Condoms

=Urinar$ tra!t in"e!tion S*erm=Menstr)a a#normait$ S*ermi!ide

=Hemorr'oids =Underear*ant$'ose

=Heat ras' =Irritation "rom=

=Uret'ra s$ndrome S'a&in%do)!'in%

As'e$ R, Lad A. Genita 'er*es+ Re&ie o" t'e e*idemi! and *otentia )se o" t$*e=

s*e!i"i! seroo%$. Cin Mi!ro#io Re& 099901+0=8


15/53

L'at Men Sa$ T'e$ T'in2 T'e$ Ha&e+

=Foi!)itis =Irritation "rom=

=Jo!2 it!' Ti%'t /eans

=Norma it!' Se


16/53

Dia%nosin% Genita Her*es

Vira !)t)re t'e %od standard

Permits &ira t$*in% di""erentiates HSV=0 "rom HSV=1

Pro*er timin% is essentia+ Vesi!e 8:=9:

Let )!er 7:=8:

Heain% )!er 5:

Dr$ )!er 1:=3:

Cr)sted esion 0:=1:

Q)ait$ o" !ini!a and a#orator$ e


17/53

Vir)s Dete!tion+ C)t)re

; God standard "or &ir)s dete!tion o" m)!o!)taneo)s 'er*es

; Re)ires i&e &ir)ses, in"e!ted !es, and s*e!ia !are

; Im*ortan!e o" sam*in% te!'ni)e Da!ron sa# Pasti! sam*in% s'a"t

; S)ita#e re"ri%erated stora%e

; Pro*er a# trans*ort

; Viroo%$ a#orator$ e


18/53

Vir)s Dete!tion Tests+ PCR

; DNA am*i"i!ation met'ods; Po$merase !'ain rea!tion

; TaMan, (i%'tC$!er met'ods

; PCR is 3 to 0: more sensiti&e t'an !)t)re

; PCR is t'e test o" !'oi!e "or dia%nosin% 'er*es sim*e<

en!e*'aitis

; CSF ta* "or HSV in neonata 'er*es CNS in"e!tion

; E


19/53

Ina!!)ra!$ o" Commer!ia Bits

?ased on Cr)de Anti%en

Cini!a !ate%or$ Corre!t dia%nosis -

Primar$ e*isode 46=75

Non*rimar$ HSV=1 :=5

Re!)rrent HSV=1 61=98

As'e$ R, Cent A, Ma%%s V, et a. Ina#iit$ o" en>$me imm)noasssa$s to

dis!riminate #eteen in"e!tions it' 'er*es sim*e< &ir)s t$*es 0 or 1.

Ann Intern Med 0990005+51:=6


20/53

Mana%in% Her*es+ T'e Underdia%nosis

o" Genita Her*es T'e Roe o" T$*e=S*e!i"i! Seroo%$

; Lestern #ot -Uni&ersit$ o" Las'in%ton, Seatte

; Her*eSee!t 0 E(ISA IGG

; Her*eSee!t 1 E(ISA IGG

; Her*eSee!t 01 Imm)no#ot

-Fo!)s Te!'noo%ies, C$*ress, Cai".

; POC2it HSV=1 Ra*id Test -Dia%noo%$ In!.

@NO (ONGER AVAI(A?(E

As'e$ R(. Genita 'er*es+ t$*e=s*e!i"i! anti#odies "or dia%nosis and mana%ement.

Dermato Cin 099806-4+789=93

As'e$ R, et a. A#iit$ o" a ra*id seroo%$ test to dete!t sero!on&ersion to 'er*es sim*e<

&ir)s t$*e 1 %$!o*rotein G soon a"ter in"e!tion. J Cin Mi!ro#io 099937-5+0631=3


21/53


22/53

Her*es Sim*e< Vir)s T$*e=S*e!i"i!

Seroo%$+ Indi!ations

; Dis!ordant !o)*es

; Esta#is' dia%nosis 'en s$m*toms or esions are s)s*e!t

#)t &ira !)t)res remain ne%ati&e

; Cassi"$ !ini!a dia%nosis

; Com*re'ensi&e STD s!reenin%

; See!ted *re%nant omen and t'eir *artners -; (ar%e=s!ae *o*)ation st)dies


23/53

L'$ Di""erentiate HSV=0 "rom HSV=1

; HSV=1 most !ommon !a)se o" %enita 'er*es

; HSV=1 in"e!tions re!)r more "re)ent$

; HSV=1 as$m*tomati! &ira s'eddin% o!!)rs o"ten

; HSV=1 sero*re&aen!e estimated #eteen 1:=35 -United States

; HSV=0 sero*re&aen!e #eteen 5:=8: -United States; HSV=0 !a)ses 3:=6: o" ne %enita in"e!tions

; Ora=%enita se


24/53

Cini!a Cassi"i!ation o" Genita Her*es

; First E*isode In"e!tion

= Primar$ in"e!tion -1:

= Non*rimar$ "irst=e*isode in"e!tion -4:

= First !ini!a e*isode o" !'roni! in"e!tion -4:

; Re!)rrent In"e!tion; S)#!ini!a In"e!tion

= Cini!a$ as$m*tomati! -as$m*tomati! s'eddin%

= Unre!o%ni>ed in"e!tion

S!'omo%$i M, Lad A, Core$ (. Her*es sim*e< &ir)s=1 in"e!tion. An emer%in% disease

In"e!t Dis Cini!s No Amer Mar!'-0 099801+47=60


25/53

Cassi"i!ation o" Genita Her*es In"e!tions

Usin% Vira C)t)re and Seroo%i! Te!'ni)es

Vira C)t)re Anti#od$ Anti#od$ Cassi"i!ation

Res)t -A!)te P'ase -Con&aes!ent o" In"e!tion

HSV=0 None HSV=0 Primar$ HSV=0

HSV=1 None HSV=1 Primar$ HSV=1

HSV=1 HSV=0 HSV=0 HSV=1 Non=*rimar$ HSV=1

HSV=0 HSV=0 Same Re!)rrent HSV=0

HSV=1 HSV=1 Same Re!)rrent HSV=1HSV=1 HSV=0 HSV=1 Same Re!)rrent HSV=1

S!'omo%$i M, Lad A, Core$ (. Her*es sim*e< &ir)s=1 in"e!tion. An emer%in% disease In"e!t

Dis Cini!s No Amer Mar!' -0 099801+47=60


26/53

Cini!a Presentation o" Genita Her*es

In"e!tions Cassi"i!ation o" S$m*tomati! Cini!a In"e!tion

Primar$ Non*rimar$ Re!)rrent

(esions Man$ #iatera Feer Fesin%eM)!osa in&o&ement Us)a Un!ommon Un)s)a

($m*'adeno*at'$ Us)a O!!asiona Un!ommon

Ne)ro*at'$ Common Un!ommon Rare

S$stemi! s$m*toms Us)a O!!asiona Rare

Us)a d)ration 1=4 ee2s 0=1 ee2s 7=0: da$s

Ada*ted "rom+ Hands"ied HH+ Cini!a mani"estations o" %enita 'er*es. In Hands"ied HH. GenitaHer*es. Ne or2, M!Gra=Hi, 1::0 -45 *a%e mono%ra*'


27/53

Genita Her*es Re!)rren!es

Fooin% *rimar$ 'er*es sim*e< in"e!tion+

; Genita HSV=1 = 89 -d)rin% t'e "irst $ear; Ora HSV=0 = 41

; Genita HSV=0 = 15

; Ora HSV=1 = 3.7

(a""ert$ LE, Coom#s RL, ?enedetti J, et a. Re!)rren!e a"ter ora and %enita 'er*es &ir)s

in"e!tion+ in")en!e o" site o" in"e!tion and &ira t$*e. N En% J Med 0987306+0444=9


28/53

Fre)en!$ o" Genita Her*es Re!)rren!es

Fooin% *rimar$ HSV=1 %enita in"e!tion+

; O&era = 89; 4: = 6 or more o)t#rea2s$ear

; 1: = 0: or more o)t#rea2s$ear

; Fre)en!$ essens o&er time

Ree&es LC, Core$ (, Adams HG, et a. Ris2 o" re!)rren!e a"ter "irst e*isodes o" %enita

'er*es. Reation to HSV t$*e and anti#od$ res*onse. N En% J Med 09803:5+305=9


29/53

Prodrome

An$ s$m*toms or des!ri#ed "eein%s t'at anno)n!e t'ea**roa!' o" a %enita 'er*es re!)rren!e+

0. It!'in% 0:. A!'in%

1. Tin%in% 00. Hea&iness

3. Soreness 01. ?r)ised "eein%s

4. Pain 03. T')m*in%

5. Sensiti&it$ 04. S)n#)rned "eein%

6. ?)rnin%05. Pins and needes sensations

7. Tenderness 06. S'ar* or d) neede s!rat!'in%8. T'ro##in% "eein%s

9. Raness

Ada*ted "rom se&era *)#i!ations and *ersona st)d$ e


30/53

As$m*tomati! Vira S'eddin% -I

; Varies a!!ordin% to 'er*es &ira t$*e

; Varies it' re!ent$ a!)ired %enita 'er*es

;Varies it' "re)en!$ o" s$m*tomati! re!)rren!es

; E


31/53

As$m*tomati! Vira S'eddin% -II

; T'e ma/orit$ o" sero*ositi&e indi&id)as *eriodi!a$ s'ed&ir)s as$m*tomati!a$

= 75 *ositi&e HSV !)t)res

= 95 *ositi&e HSV #$ PCR

; S'eddin% o!!)rs on 1=8 o" da$s= 1.7 o" da$s it' on$ AVS

; S'eddin% d)ration a&era%es 3 da$s

= Man$ s'ed on$ 0 da$

; AVS essens in time

Boee DM, Lad A. Her*es sim*e< &ir)s+ t'e im*ortan!e o" as$m*tomati! s'eddin%.

J Antimi!ro#io C'emot' 1:::45, To*i! T3,0=8


32/53

O""i!e Mana%ement o" Genita Her*es

An inte%rated a**roa!' to 'er*es mana%ement+

; Dia%nosis and isoation o" 'er*es sim*e< &ir)ses; Di""erentiation o" 'er*es &ira t$*e

; Tria%e and !assi"i!ation o" %enita 'er*es in"e!tion

; Mana%ement %oas and !onsiderations

; Re!ommended anti&ira medi!ations

Ada*ted "rom *ersona st)d$ and !ini!a e


33/53

(essenin% Genita Her*es Transmission+ Use

o" Condoms

; Reati&e transmission ris2 -'a>ard ratio amon% !o)*esit' K15 !ondom )se, &s X15 )se+

= Mae to "emae :.:85 -CI 95 :.:0=:.67

= Femae to mae 1.:1 -CI 95 :.31=01.5

; Reati&e HSV=1 in"e!tion ris2 -'a>ard ratio amon% *ersons it' K65 !ondom )se, &s X65 )se+

= Men :.58 -CI 95 :.37=:.91

= Lomen :.66 -CI 95 :.3:=0.46

Lad A, (an%en#er% AG, (in2 B, et a. E""e!t o" !ondoms on red)!in% t'e transmission

o" 'er*es sim*e< &ir)s t$*e 1 "rom men to omen. JAMA 1::0185+30::=6


34/53

Genita Her*es as a Pre%nan!$ Com*i!ation

; First Trimester Possi#iit$ o" !on%enita anomaies

Ris2s o" s*ontaneo)s *re%nan!$ oss

; Se!ond Trimester

Ris2 o" intra=)terine %rot' retardation

Possi#iit$ o" e


35/53

Mot'er to In"ant Transmission o" Her*es

Sim*e< Vir)s -I

; 58,361 *atients -0981=0999

; 08 !ases o" neonata 'er*es -0+31:: #irt's

-808 HSV=0 -0:08 HSV=1

; 4:,:13 HSV !)t)res -!er&i< and &)&a

; 1:1 !)t)res *ositi&e "or 'er*es sim*e< &ir)s -:.5

Vir)ses isoated d)rin% a#or

?ron A, Lad A, As'e$ Morro RA, Se2e S, e' J, Core$ (. E""e!t o"

seroo%i! stat)s and !esarean dei&er$ on transmission rates o" 'er*es sim*e<

&ir)s "rom mot'er to in"ant. JAMA 1::3189-1+1:3=9


36/53

Mot'er to In"ant Transmission o" Her*es

Sim*e< Vir)s &s Seroo%i! Stat)s -II

; Primar$ HSV in"e!tion HSV=0 3 !ases+ 3 !ases o" neonata 'er*es

HSV=1 6 !ases+ 0 !ase o" neonata 'er*es

; Non*rimar$ HSV in"e!tion

HSV=0 0 !ase+ no neonata 'er*es HSV=1 06 !ases+ 4 neonata 'er*es in"e!tions

; Rea!ti&ation -Re!)rrent HSV in"e!tion HSV=0 00 !ases+ 1 neonata 'er*es in"e!tions

HSV=1 04: !ases+ no neonata 'er*es





37/53

Mot'er to In"ant Transmission Rates o"

Her*es Sim*e< Vir)s &s Dei&er$ Met'od

And Seroo%i! Stat)s -III

; Neonata In"e!tion Rates -&s Met'od o" Dei&er$ 085 !esarean #irt's -0.1

9007 &a%ina #irt's -7.7

; Neonata In"e!tion Rates -&s Seroo%$ Serone%ati&e omen 540::,:::

HSV=0 sero*ositi&e 160::,:::

HSV=1 sero*ositi&e 110::,:::





38/53

Mot'er to In"ant Transmission Rates o"

Her*es Sim*e< Vir)s O&era Ris2 Fa!tors

-IV; HSV isoated at dei&er$ -Odds Ratio 346

; First e*isode %enita 'er*es -OR 33.0

; HSV isoated "rom t'e !er&i< -OR 31.6

; HSV=0 isoated -OR 06.5; In&asi&e monitorin% -OR 6.8

; Premat)re dei&er$, X38 ee2s -OR 4.4

; Materna a%e X10 -OR 4.0

;Va%ina dei&er$ -OR :.04

?ron A, Lad A, As'e$ Morro RA, Se2e S, e' J, Core$ (. E""e!t o" seroo%i! stat)s

and !esarean dei&er$ on transmission rates o" 'er*es sim*e< &ir)s "rom mot'er to in"ant. JAMA

1::3189-1+1:3=9


39/53

S)mmar$

0. T'e in!iden!e o" %enita 'er*es is !ontin)o)s$ risin%

1. T'e *re&aen!e o" %enita 'er*es 'as in!reased 3:

3. A**roed e&a)ation


40/53

MANAGING GENITA( HERPES+

ANTIVIRA( THERAP Jerome M. Eder, MD

Assistant Cini!a Pro"essor De*artment o" O#stetri!s and G$ne!oo%$

Da&id Ge""en S!'oo o" Medi!ine at UC(A

Medi!a Ad&isor

(os An%ees HE(P Gro)*

Her*es Reso)r!e Center


41/53

Mana%in% Her*es+ Goas o" Medi!a T'era*$

; Reie&e s$m*toms

; A!!eerate 'eain% o" esions

; Red)!e ris2s o" %enita 'er*es re!)rren!es

(essen as$m*tomati! &ira s'eddin%

; Red)!e &ira transmission

De!rease &ira in"e!tio)sness -

O#stetri!a )se d)rin% *re%nan!$ -

; Re=im*oer t'e indi&id)a

(essen 'er*es an


42/53

Mana%in% Her*es+ Usin% Anti&ira

Medi!ations

C)rrent$ a&aia#e anti&iras ma$ #e *res!ri#ed "or+

; First !ini!a e*isode o" %enita 'er*es Primar$ in"e!tion

Initia non=*rimar$ in"e!tion

; Re!)rrent e*isodes o" HSV disease

; S)**ressi&e t'era*$ "or re!)rrin% %enita 'er*es

Centers "or Disease Contro and Pre&ention. Se


43/53

Her*es Anti&ira T'era*$

; First %eneration

= A!$!o&ir -o&ira


44/53

A!$!o&ir+ (a#orator$ St)dies

A!$!o&ir+ -9=-1='$dro


45/53

Initia Anti&ira T'era*$

-Primar$First Cini!a E*isode o" Genita Her*es

Acyclovir 4:: m% ora$ t'ree times a da$ "or 7=0: da$s

OR

Acyclovir 1:: m% ora$ "i&e times a da$ "or 7=0: da$sOR

Famciclovir 15: m% ora$ t'ree times a da$ "or 7=0: da$s

(NOT FDA APPROVED)

OR Valacyclovir 0.: %ram ora$ ti!e a da$ "or 7=0: da$s



46/53

E*isodi! Anti&ira T'era*$

Acyclovir 4:: m% ora$ t'ree times a da$ "or 5 da$s

OR

Acyclovir 1:: m% ora$ "i&e times a da$ "or 5 da$s

OR

Acyclovir 8:: m% ora$ ti!e a da$ "or 5 da$s

OR

Famciclovir 015 m% ti!e a da$ "or 5 da$s

OR

Valacyclovir 5:: m% ti!e a da$ "or 3=5 da$s

OR

Valacyclovir 0.: %ram ora$ on!e a da$ "or 5 da$s

Centers "or disease Contro and Pre&ention. Se


47/53

S)**ressi&e T'era*$ For Re!)rrent

Genita Her*es

Acyclovir 4:: m% ora$ ti!e *er da$

OR

Famciclovir 15: m% ora$ ti!e *er da$

OR

Valacyclovir 5:: m% ora$ on!e dai$

OR

Valacyclovir 0.: %ram ora$ on!e dai$



48/53

Emotiona Im*a!t Asso!iated Lit' Possi#$

Contra!tin% Genita Her*es

; ?e!omin% in"e!ted it' AIDS 96

; Contra!tin% %enita 'er*es 68

; ?rea2in% )* a si%ni"i!ant reations'i* 54

; Gettin% "ired "rom $o)r /o# 50

; Faiin% a !o)rse in s!'oo 18

Ameri!an So!ia Heat' Asso!iation, s)r&e$ o" 0::: US ad)ts. Presented att'e Internationa So!iet$ "or STD Resear!' J)$ 0999, Den&er, CO


49/53

Ps$!'oso!ia Co)nsein% and Persona

Con!erns Re%ardin% Genita Her*es

Initia Dia%nosis; An%er, Ra%e, Sorro, De*ression, An%)is', G)it

; Pani!, He*essness, Re%ret, Red)!ed se"=esteem

Re!)rrent Disease; Fears o" re/e!tion or in"e!tin% a ne *artner

; Fears o" in"e!tin% !'idren or "ami$ mem#ers

; Fear o" *ain") sores )n!ertaint$ o" ")t)re re!)rren!es

; Fear o" aa$s #ein% !onta%io)s o" #ein% )n!ean

; Fears o" "emae !an!er in"e!tin% a ne#orn

Ada*ted "rom Ameri!an So!ia Heat' Asso!iation and Internationa Her*es Aian!e

Conant MA, ?er%er TG, Coates, et a. Genita 'er*es+ an inte%rated a**roa!'. J Am

A!ad Derm 099635+6:0=5


50/53

Emotions Re*orted A"ter Contra!tin%

Genita Her*es

; 40 re*orted "eein%s o" de*ression asso!iated it'

s$m*tomati! %enita 'er*es

; 34 re*orted #ein% orried a#o)t 'er*es and its im*a!t on

t'eir !)rrent reations'i*

; 30 re*orted *ro#ems in esta#is'in% a ne reations'i*

Ada*ted "rom Ga


51/53


52/53

Mana%in% Genita Her*es+

S)mmar$

; A&aia#e *res!ri*tion n)!eoside anao%)es are sa"e

; A are e""e!ti&e -No dire!t !om*arati&e trias

; Ind)!ed resistant &ira strains are not a !on!ern in imm)no=!om*etent

indi&id)as; A&aia#e *res!ri*tion anti&iras are FDA !assi"ied as Cate%or$ ?

dr)%s "or )se d)rin% *re%nan!$

; A ma$ #e e


53/53

Additiona Reso)r!es; Ameri!an So!ia Heat' Asso!iation -ASHA

Nationa Her*es Hotine -909 360=8488 STD Hotine -8:: 117=8911

Le#site .as'astd.or%

; Ga

Understanding Herpes

Documents

Transcript of Understanding Herpes