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HERPES GENITALIS

Indah Yulianto
I.K.K.K.-FK. UNS
SOLO

ETIOLOGI

INFLAMASI AKUT ok virus Herpes Simplex


YANG MENGENAI PRIA MAUPUN
PEREMPUAN
Genital herpes 30% disebabkan HSV-1,yang ok
HSV-2 bersifat rekurensi
Secara garis besar HSV-1 mengenai pinggang
keatas dan HSV-2 pinggang kebawah
Infeksi awitan HV-1 non genital, HSV-2 melalui
kontak seksual

Epidemiologi

Didunia telah mengenai 10% penduduk


dunia terutama pada usia muda (20 25
th)
75% orang yang telah terinfeksi tidak
memberikan gejala apapun, bahaya
sebagai carier
HSV-2 tidak hanya melalui kontak seksual
tetapi juga ditularkan pada anak dari ibu
yang hamil

Manifestasi Klinik

Inkubasi 2-7 hari (2-21 hari)


Infeksi primer: nyeri lokal, sensasi gatal,
dysuria, pada wanita keluar duh tubuh
vagina yang berlebihan
Lesi primer berupa papula yang cepat
berubah menjadi vesikula yang mudah
pecah ok dinding tipis
Pada wanita: labia mayora dan
minora,mukosa vaginal dan cervix
Pria: batang penis
Sekrit vesikula sangat menular

Rekurensi

Terutama yang disebabkan HSV-2


Lesi sama tetapi tidak terlalu sakit
Biasanya dalam kurun waktu 6-8 minggu
serta dipicu berbagai faktor pencetus
seperti
Stress, haid, hubungan kelamin, penyakit
dalam yang mendasari seperti DM,
hipertensi serta
Peminum alkohol, obat penenang dan
Pajanan sinar ultra violet

Clinical Manifestations
HSV is involved in a variety of clinical manifestations which
includes ;1. Acute gingivostomatitis
2. Herpes Labialis (cold sore)
3. Ocular Herpes
4. Herpes Genitalis
5. Other forms of cutaneous herpes
7. Meningitis
8. Encephalitis
9. Neonatal herpes

Oral-facial Herpes

Acute Gingivostomatitis

Acute gingivostomatitis is the commonest manifestation of primary herpetic


infection.
The patient experiences pain and bleeding of the gums. 1 - 8 mm ulcers with
necrotic bases are present. Neck glands are commonly enlarged accompanied by
fever.
Usually a self limiting disease which lasts around 13 days.

Herpes labialis (cold sore)

Following primary infection, 45% of orally infected individuals will experience


reactivation. The actual frequency of recurrences varies widely between individuals.
Herpes labialis (cold sore) is a recurrence of oral HSV.
A prodrome of tingling, warmth or itching at the site usually heralds the recurrence.
About 12 hours later, redness appears followed by papules and then vesicles.

Herpes genitalis batang penis

Genital Herpes

Genital lesions may be primary, recurrent or initial.

Many sites can be involved which includes the penis, vagina, cervix, anus,
vulva, bladder, the sacral nerve routes, the spinal and the meninges. The
lesions of genital herpes are particularly prone to secondary bacterial
infection eg. S.aureus, Streptococcus, Trichomonas and Candida Albicans.

Dysuria is a common complaint, in severe cases, there may be urinary


retention.

Local sensory nerves may be involved leading to the development of a


radiculitis. A mild meningitis may be present.

60% of patients with genital herpes will experience recurrences. Recurrent


lesions in the perianal area tend to be more numerous and persists longer
than their oral HSV-1 counterparts.

Differential Dx Herpes Simplex


Herpes Simplex
Lesions begin as painful, pruritic grouped vesicles
Vesicles break down to form an ulcer
Lesions are located in the anogenital area

Cutaneous anthrax
Ulcer is painless
Lesion is located on exposed parts of the body
Ulcer and eschar are surrounded by characteristic non-pitting
edema

Pathophysiologi
Virus
Virusmelalui
melaluimikro
mikrolesi
lesikulit
kulit

Infeksi
Infeksiakut
akut(symptomatis
(symptomatisatau
atau
asymptomatis)
asymptomatis)
Penyembuhan
Penyembuhandari
dariinfeksi
infeksiakut
akut

Infeksi
Infeksilaten,
laten,virus
virusdorman
dormanpada
pada
ganglion
gangliondorsalis
dorsalis(neuron)
(neuron)yang
yang
menginervasi
lesi
awitan
akut
menginervasi lesi awitan akut
Rekurensi
RekurensiHSV
HSVbaik
baikklinis
klinis
maupun
maupunsub
subklinis
klinis

Reaktivasi
Reaktivasivirus
virus

Virus
Virusdilepaskan
dilepaskan
dari
dariganglion
ganglion
dorsalis
dorsalis

Diagnosis

Anamnesis : CS (+), lesi vesikel


bergerombol diatas kulit eritematosa daerah
genital atau pada mukosa mulut dan sekitar
bibir
Laboratorium :
Eksiminasi sitologi : multi nucleated giant
cells
Direct immune fluorescent staining (hanya
dikerjakan pada penelitian)

Pengobatan pada serangan


yang pertama
Acyclovir

200
200 mg/5x/10
mg/5x/10 hari
hari
atau
atau
400mg/3x/7-10
400mg/3x/7-10 hari
hari

Valacyclovir

Famcyclovir

11 gg // 2x
2x // 10
10 hari
hari

250
250mg/3x/7-10
mg/3x/7-10hari
hari

Herpes Rekurensi
200 mg/ 5x/5 hari
R/Acyclovir

400 mg/ 3x/ 5 hari

800 mg/ 2x/5 hari

800 mg/3x / 2 hari

Herpes Rekurensi
500
500mg/2x/3
mg/2x/3hari
hari
R/ Vala
cyclovir

500
500mg/2x/2
mg/2x/2hari
hari

1gr
1gr/2x
/2x//3hari
3hari

Herpes Rekurensi

R/Vamcyclovir
125 mg / 2x / 5 hari

Varicella- Zoster Virus

Properties

Belong to the alphaherpesvirus subfamily of herpesviruses

Double stranded DNA enveloped virus

Genome size 125 kbp, long and short fragments with a total of
4 isometric forms.

One antigenic serotype only, although there is some cross


reaction with HSV.

Pathogenesis

The virus is thought to gain entry via the respiratory tract and
spreads shortly after to the lymphoid system.

After an incubation period of 14 days, the virus arrives at its main


target organ, the skin.

Following the primary infection, the virus remains latent in the


cerebral or posterior root ganglia. In 10 - 20% of individuals, a
single recurrent infection occurs after several decades.

The virus reactivates in the ganglion and tracks down the sensory
nerve to the area of the skin innervated by the nerve, producing a
varicellaform rash in the distribution of a dermatome.

Herpes Zoster (Shingles)

Herpes Zoster mainly affect a single dermatome of the skin.

It may occur at any age but the vast majority of patients are more than 50 years of
age.

The latent virus reactivates in a sensory ganglion and tracks down the sensory
nerve to the appropriate segment.

There is a characteristic eruption of vesicles in the dermatome which is often


accompanied by intensive pain which may last for months (postherpetic neuralgia)

Herpes zoster affecting the eye and face may pose great problems.

As with varicella, herpes zoster in a far greater problem in immunocompromised


patients in whom the reactivation occurs earlier in life and multiple attacks occur as
well as complications.

Complications are rare and include encephalitis and disseminated herpes zoster.

Shingles

Laboratory Diagnosis
The clinical presentations of varicella or zoster are so characteristic
that laboratory confirmation is rarely required. Laboratory diagnosis is
required only for atypical presentations, particularly in the
immunocompromised.

Virus Isolation - rarely carried out as it requires 2-3 weeks for a results.

Direct detection - electron microscopy may be used for vesicle fluids but
cannot distinguish between HSV and VZV. Immunofluorescense on skin
scrappings can distinguish between the two.

Serology - the presence of VZV IgG is indicative of past infection and


immunity. The presence of IgM is indicative of recent primary infection.

Cytopathic Effect of VZV

Cytopathic Effect of VZV in cell culture: Note the ballooning of cells. (Coutesy of
Linda Stannard, University of Cape Town, S.A.)