Genital Herpes

HISTORY:

Painful genital ‍ulcersblisterssores for ‍ ‍hoursdays

Location: ‍penisscrotumvulvavaginaperineumanus

‍painful ulcers

‍blisters

‍sores

‍burning

‍itching

‍tingling

‍dysuria

‍urinary retention

‍vaginal discharge, ‍clear, ‍thin

‍fishy smell

‍urethral discharge

‍swollen lymph nodes in the groin

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍headache

‍muscle aches

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash



ASSESSMENT:

‍Genital herpes ‍likelysuspectedpossible

DDx: ‍



PLAN:

- HSV swab

- STI screening for chlamydia and gonorrhea

- Blood work: ‍HSV serology, ‍HIV, ‍Syphilis, ‍Hepatitis B, ‍Hepatitis C

- Urinalysis

- Urine culture

- ‍Primo HSV antivirals

- ‍Recurrent HSV antivirals

- ‍Analgesics

- Topical lidocaine for pain relief

- Abstinence during outbreaks and when symptoms present

- Counseling on condom use, advise to inform partners of transmission risk even with condom use

- Referral to gynecologist

- Referral to urologist

- Referral to infectious disease specialist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever

- Go to ER if severe pain, inability to urinate, or systemic symptoms occur