Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
I. IDENTIFICATION
A. CLINICAL DESCRIPTION: A sexually transmitted diseased caused by the HerpesSimplex Virus (HSV). Two sero-types of HSV have been identified: HSV-1 and HSV-2; most oral infections are caused by HSV-1, while most genital infections are cause by HSV-2. The infection is characterized by lesions that may occur on the female’s cervix and vulva and on the prepuce in males. Dependent upon the sexual practices of the individual, lesions may also occur on the mouth and anus. There is no cure for herpes, however, the lesions usually resolve in 4-12 days. The lesion/s (outbreak) may recur after the first episode, more frequently within the first years of infection and less frequent in subsequent years. The infection is acquired by skin to skin contact with lesion or during sexual contact. In addition, many cases of HSV are acquired from persons who do not know that they have the infection, or who were asymptomatic at the time of sexual contact. Pregnant women who deliver vaginally with active genital herpes may infect the newborn. The newborn risk is at risk for disseminated visceral infection, encephalitis, and death. As with other infections that cause genital lesions, there is an increased risk of HIV infection.
B. REPORTING CRITERIA: Laboratory confirmation.
C. LABORATORY CRITERIA FOR CONFIRMATION: (Any new tests?)
- Isolation of herpes simplex virus from cervix, urethra, or anogenital lesion, OR
- Demonstration of virus by antigen detection technique in clinical specimens from cervix, urethra, or anogenital lesion, OR
- Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion.
D. WISCONSIN CASE DEFINITION: A laboratory confirmed infection.
II. ACTIONS REQUIREDA. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.
B. EPIDEMIOLOGY REPORTS REQUESTED:
- Acute and Communicable Diseases Case Report (DPH 4151).
- Sexually Transmitted Diseases Morbidity and Epidemiologic Case Report (DPH 4243).
C. PUBLIC HEALTH INTERVENTIONS: Patients with genital herpes should be counseled for their risk of HIV and in methods to reduce their risk for acquiring STDs including HIV.
- Patients should be advised to abstain from sexual activity while lesions are present.
- Sex partners of patients should be evaluated and counseled.
- Patients should be educated about the disease and the potential for recurrence. Educational messages should also focus on the potential for transmission while the individual is asymptomatic and the danger to newborns during the birth process.
III. CONTACTS FOR CONSULTATIONA. BCDP / COMMUNICABLE DISEASE STD UNIT: (608) 266-7365.
B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.
C. WSLH / BACTERIOLOGY: (608) 262-1616.
D. MILWAUKEE BUREAU OF LABORATORIES: (414) 286-3526.
IV. PREVENTION MEASURES:A. Patients treated for HSV should be counseled regarding their risk for HIV infection and in methods to reduce their risk of acquiring other sexually transmitted diseases.
B. Follow-up of all patients having lesions with a serologic test for syphilis.
C. Treatment: There is no cure for herpes, but acyclovir provides partial control of symptoms.
First Clinical Episode of Genital HerpesRecommended Regimen
Acyclovir 200 mg orally 5 times for 7-10 days or until clinical resolution is attained.
First Clinical Episode of Herpes Proctitis
Recommended Regimen
Acyclovir 400 mg orally 5 times a day for 10 days or until clinical resolution is attained
Recurrent EpisodesWhen treatment is instituted during the prodrome or within 2 days of onset of lesions, some patients with recurrent disease experience limited benefits. However, since early treatment can seldom be administered, most immunocompetent patients with recurrent disease do not benefit from acyclovir treatment, and it is not generally recommended.
Recommended Regimen
Acyclovir 200 mg orally 5 times a day for 5 days, OR
Acyclovir 400 mg orally 3 times a day for 5 days, OR
Acyclovir 800 mg orally 2 times a day for 5 days
Daily Suppressive Therapy
Daily suppressive therapy reduces the frequency of HSV recurrence by at least 75% among patients with frequent recurrences (e.g., six or more recurrences per year). Suppressive treatment with oral acyclovir does not totally eliminate symptomatic or asymptomatic viral shedding or the potential for transmission. Safety and efficacy have been documented among persons receiving daily therapy for as long as 5 years. Acyclovir-resistant strains have not been associated with treatment failure among immunocompetent patients. After one year of continuous suppressive therapy, acyclovir should be discontinued to allow assessment of the patient’s rate of recurrent episodes.
Recommended Regimen
Acyclovir 400 mg orally 2 times a day
Alternative Regimen
Acyclovir 200 mg orally 3-5 times a day
The goal of the alternative regimen is to identify, or each patient, the lowest dose that provides relief from frequently recurring symptoms.
Severe DiseaseIntravenous (IV) therapy should be provided for patients with severe disease or complications necessitating hospitalization (e.g. disseminated infection that includes encephalitis, pneumonitis, or hepatitis).
Recommended Regimen
Acyclovir 200 mg/kg body weight IV every 8 hours for 5-7 days or until clinical resolution is attained
V. RELATED REFERENCES
1. Sexually Transmitted Diseases Treatment Guidelines --- 2002. MMWR 2002;51(RR06):1-80
2. Sexually Transmitted Diseases Clinical Practice Guidelines, 1991, CDC.
3. Heymann DL, ed. HERPES SIMPLEX. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:268-272
4. Wisconsin Administrative Code, Chapter HSS, 1991, No. 430.