Genital Herpes

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of painful genital ‍ulcersblisterssores

Location is on ‍penisscrotumvulvavaginaperineumanus

Symptoms include:

‍painful ulcers

‍blisters

‍sores

‍burning

‍itching

‍tingling

‍dysuria

‍urinary retention

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍urethral discharge

‍swollen lymph nodes in the groin

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍muscle aches



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

‍sexual exposure to someone with genital herpes

no history of: ‍genital herpes, ‍sexually transmitted infections, ‍HIV, ‍immunodeficiency





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Genital herpes ‍likelysuspectedpossible

DDx: genital herpes, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, genital warts (HPV), yeast infection, bacterial vaginosis, trichomoniasis, scabies, pubic lice, bartholinitis, contact dermatitis, psoriasis, lichen planus, lichen sclerosus





PLAN:

Investigations:

- HSV swab

- STI screening for chlamydia and gonorrhea

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

- Urinalysis

- Urine culture

Treatments:

- ‍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

Further care:

- 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

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