Herpes Genitalis pada Kehamilan

Herpes genitalis pada kehamilan merupakan infeksi pada genital disebabkan Herpes simplex virus (HSV) dengan gejala berupa vesikel berkelompok dengan dasar eritema dan bersifat rekurens pada perempuan hamil. HSV dibagi menjadi HSV-1 dan HSV-2. HSV-2 paling sering menyebabkan herpes genital sekitar 82% kasus ditularkan melalui kontak seksual, HSV-1 lebih sering menyebabkan herpes non-genital, tetapi terjadi peningkatan kasus herpes genitalis diakibatkan HSV-1 karena praktek seksual orogenital. Penelitian tahun 2000-2001 dilakukan pada sekitar 16.000 ibu hamil melaporkan 16% terinfeksi HSV-2 dan 66% terinfeksi HSV-1. Infeksi HSV dibagi menjadi infeksi primer, non-primer, rekurens, dan asimptomatis. Frekuensi infeksi HSV neonatus di Amerika Serikat adalah 1/12500 kelahiran hidup. Herpes genitalis pada kehamilan memungkinkan penularan ke janin pada masa intrauterine 5%, perinatal 85%, atau postnatal 10%. Metode pewarnaan Giemsa, kultur HSV, biologi molekular (PCR), pemeriksaan histopatologi, atau serologi membantu menegakan diagnosis HSV. Penularan pada janin dapat menyebabkan abortus, stillbirth, pertumbuhan terhambat, kelainan kongenital, dan kematian. Penggunaan asiklovir atau valasiklovir pada ibu hamil sebagai terapi utama dan terapi supresif. Terapi supresif digunakan untuk mencegah, menurunkan frekuensi rekurensi, menurunkan penularan selama kehamilan, dan menurunkan angka pelaksanaan sectio caesaria. Infeksi herpes genitalis pada kehamilan diatas 34 minggu direncanakan sectio caesarea untuk mengurangi risiko transmisi virus ke bayi. Kontak lama neonatus dengan jalur persalinan pada saat melahirkan spontan akan meningkatkan risiko tertularnya neonatus oleh HSV. Kata Kunci : Herpes Genital, Kehamilan, HSV, Sectio Cesarea, Terapi Supresif

Clinical and laboratory profiles of genital ulcers (sexually transmitted diseases) in a tertiary care center in northeastern India

Background: Genital ulcers are defined as breaches in the continuity of the genital mucosa and/or skin. Sexually transmitted infections (STIs) that cause genital ulcer disease (GUD) are syphilis, chancroid, donovanosis, lymphogranuloma venereum (LGV), and herpes genitalis. This study aimed to investigate the clinical and laboratory profiles of STI-related genital ulcers. Materials and Methods: A cross-sectional two-year study was conducted on patients attending the Outpatient Department of Dermatology, Venereology and Leprosy in a tertiary care center in northeastern India. Selected were 95 patients who presented themselves with STI-related genital ulcers. Detailed history taking and examination were conducted with basic tests to assist the diagnosis. Results: The male-to-female ratio was 3.32:1, and the most common site was the glans and prepuce in males (28.77%) and the labia majora and minora in females (36.36%). 96.84% of patients had superficial ulcers. The KOH mount was positive in 26 patients. The Tzanck smear was positive in 31 patients. RPR was positive in four. HIV was positive in eleven. Herpes genitalis (96.84%) was the most common GUD. Mixed STIs were attested in 41.05% of patients. Conclusion: GUD can take various forms of presentation. The available laboratory tests should be utilized. The possibility of mixed infections should always be kept in mind.

Herpes febrilis и herpes genitalis

It is still unclear whether the causative agents of both of these diseases are identical or different. Lipschutz (Arch. F. Derm. U. Sypb., 1925, Bd. 149) indicates the difference between them on the basis of: 1) his own observations during experimental infection of human skin with a virus of both forms: 2) different duration of evolution of keratitis in a rabbit after vaccination of both viruses and 3) is different in histological skin lesions. A comparison of a number of clinical observations also indicates a difference in the etiological moment for both herpes species.

Genital vesicobullous disease-not herpes genitalis!

<p>Genital bullous pemphigoid (BP), a localized subset of bullous pemphigoid, has been identified in children and women in the past. However, we report an adult male presenting with blisters confined to glans and shaft of penis, mimicking herpes genitalis, failing antiviral therapy. The patient responded to treatment with dapsone.</p>

Herpetiform aphthous genital ulcers misdiagnosed as herpes genitalis in a young male and their effective response to colchicine therapy

Genital ulceration can be a source of tremendous stress to the patient, as well as to the family members, and poses a difficult and sensitive diagnostic conundrum for the clinician. Cultural taboos and social stigmas related with the disease often result in the clinician not believing the patient’s version of history and basing the diagnosis entirely upon the clinical picture, aided by diagnostic tests. The clinicians should keep in mind that sexually transmitted infections (STIs), which can cause genital ulceration are very common, but there is a long list of non-sexually acquired causes of genital ulceration, which can lead to a diagnostic dilemma, and these should be considered before labelling the patient as suffering from a STI. We present a rare case of herpetiform genital aphthous ulcers mimicking herpes genitalis and chancroid, which was misdiagnosed repeatedly, and their effective response to treatment with colchicine on subsequent identification of the correct diagnosis.

Penyakit Adamantiades-Behcet Koinfeksi dengan Herpes Genital

Adamantiades-Behcet (AB) disease is a rare multi-systemic inflammatory disorder with unknown cause. It is characterized by recurrent mucocutaneous ulcer in the mouth and genitalia, and mostly affects the age group of 20 to 30 ys. Genital lesion of AB must be differentiated from others caused by sexually transmitted disease, such as genital herpes. Co-infection of AB with genital herpes is very rare. We reported a male 72-year old, came with painful ulcers in the mouth and genital area since a week before visit. Symptoms were recurrent since three years ago. History of arthritis, recurrent headache, eye and skin lesions were denied. Patient was sexually promiscuous. Physical examination revealed multiple ulcers on the labium oris sized 0.5cm-1cm, irregular border, base covered by fibrin tissue, associated with erosion and crust. Multiple ulcers were also found on penile glans, sized 0.1x1x0.2 cm, irregular border, with pus and necrotic tissue. The ulcers were punched out. Pathergy test and anti HSV-1 IgM were negative meanwhile anti HSV-1 IgG, anti HSV-2 IgM as well as anti HSV-2 IgG were positive. Acyclovir 200mg 5x/day for five days, triamcinolone acetonide lotion bid for the mouth ulcer, NaCl 0,9% dressing applied tid for 30 minutes, and fucidic acid cream bid were given and the symptoms improved after 10 days. The prognosis was bonam for ad vitam and dubia for ad functionam and ad sanationam. Conclusion: The diagnosis of AB was based on the International Criteria for Behcet Disease, with a total score of 4 for the recurrent ulcer in mouth and genital area. The positive result of anti HSV-1 IgG, anti HSV-2 IgM and anti HSV-2 IgG supported the coinfection with genital herpes. This coinfection of AB and genital herpes was the first reported in Manado. Immunosenescence was a possible risk factor of the recurrent genital herpes. Symptomatic and antiviral treatment improved the symptoms with possible recurrent genital herpes.Keywords: Adamantiades-Behcet, genital herpes, coinfectionAbstrak: Penyakit Adamantiades-Behçet (AB) merupakan kelainan inflamasi multisistemik yang tidak diketahui penyebabnya dengan manifestasi mukokutan tersering berupa ulkus berulang pada mulut dan genital. Penyakit ini terutama terjadi pada usia 20-30an. Lesi genital pada AB perlu dibedakan dengan ulkus genital akibat infeksi menular seksual termasuk herpes genitalis. Koinfeksi AB dan herpes genitalis jarang terjadi. Kami melaporkan kasus seorang laki-laki, usia 72 tahun, dengan keluhan luka di bibir dan kelamin yang nyeri sejak 1 minggu lalu, bersifat hilang-timbul selama 3 tahun terakhir. Riwayat nyeri sendi, sakit kepala berulang, serta kelainan kulit disangkal. Terdapat riwayat promiskuitas yang tinggi. Pada pemeriksaan fisik di regio labialis oris ditemukan ulkus multipel, diameter ±0,5-1 cm, tepi tidak teratur, dasar tertutup jaringan fibrin, dengan erosi dan krusta. Di regio glans penis ditemukan ulkus multipel, ukuran bervariasi ± 1x2x0,2cm, tepi tidak teratur, dasar tertutup pus dan jaringan nekrotik, terdapat punch out dan erosi. Tes patergi negatif. Pemeriksaan anti HSV-1 IgM (-), anti HSV-1 IgG (+), anti HSV-2 IgM dan IgG (+). Terapi asiklovir 5 x 200 mg/hari selama 5 hari, salep triamsinolon asetonid 2 kali oles, kompres terbuka NaCl 0,9% 3 x30 menit/hari, krim asam fusidat 2 kali oles, memberikan perbaikan klinis setelah 10 hari pengobatan. Prognosis quo ad vitam bonam, quo ad functionam, quo ad sanationam ad dubia. Simpulan: Pada kasus ini, diagnosis AB ditegakkan berdasarkan International Criteria for Behcet Disease yaitu ditemukannya ulkus berulang di mulut dan di genital, masing-masing mendapat nilai 2, sehingga nilai total ialah 4. Ditemukannya anti HSV-1 IgG, anti HSV-2 IgG dan IgM positif, menunjang diagnosis tambahan herpes genital (rekuren). Koinfeksi AB dengan herpes genital baru pertama kali dijumpai di Manado. Keadaan immunosenescence kemungkinan menjadi faktor pencetus terjadinya rekurensi herpes genital. Pasien sembuh dengan terapi simtomatis dan antivirus, meskipun kemungkinan rekurensi dapat terjadi lagi.Kata kunci: Adamantiades-Behcet, herpes genital, koinfeksi