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Herpes Simplex image


  • Herpes Simplex virus
  • type II (genital) (90%),
  • type I (oral) (10%)


Initial symptoms

  1. present 2-21 days following contact
  2. prodromal symptoms
    • tingling, burning, pruritus
  3. multiple, painful, shallow ulcerations with small vesicles
    • these lesions are infectious
    • lesions appear 7-10 days after initial infection
  4. inguinal lymphadenopathy, malaise, fever often with first infection
  5. dysuria and urinary retention if urethral mucosa affected
  6. may be asymptomatic
  7. recurrent infections
    • less severe, less frequent and shorter in duration



  1. viral culture
  2. cytologic smear
    • multinucleated giant cells
    • acidophilic intranuclear inclusion bodies
  3. virus seen on electron microscopy



  1. symptomatic
  2. acyclovir 200 mg 5 times a day for 5 days decreases duration and severity of acute phase
  3. treat secondary infection
    • famciclovir, less frequent dosing and shorter duration of treatment for recurrent genital herpes
  4. consider suppressive therapy if 6-8 attacks per year
  5. education regarding transmission
    • avoid contact from prodrome until lesions have cleared
    • use barrier contraception





  • Treponema pallidum


Primary syphilis

  1. painless chancre on vulva, vagina or cervix
  2. painless inguinal lymphadenopathy
  3. 3-4 weeks after exposure
  4. serological tests usually negative


Secondary syphilis

  1. 2-6 months after initial infection
  2. nonspecific symptoms  :  malaise, anorexia, headache, diffuse adenopathy
  3. generalized maculopapular rash  : palms, soles, trunk, limbs
  4. condylomata lata (anogenital, broad-based fleshy grey lesions)
  5. serological tests usually positive


Tertiary syphilis

  1. may involve any organ system
  2. gumma of vulva
  3. neurological: tabes dorsalis, general paresis
  4. cardiovascular: aortic aneurysm, dilated aortic root


Congenital syphilis

  • may cause fetal anomalies, stillbirths or neonatal death


Latent syphilis

  • no symptoms, positive serology


Natural history

if untreated, 1/3 will experience late complications



  1. aspirate of ulcer serum or node :spirochetes on dark ground microscopy
  2. serology
    • VDRL is non-specific
    • MHA-TP is the confirmatory test (microhemagglutination-Treponema pallidum)
    • FTA-ABS is specific (Fluorescent Treponemal Antibody-absorption)
    • TPI (Treponema pallidum immobilizatio) is the most specific test, most expensive


Treatment of primary, secondary, latent syphilis of < 1 year duration

  1. benzathine penicillin G 2.4 million units IM
  2. treat partners
  3. reportable disease


Treatment of latent syphilis > 1 year duration

  1. benzathine penicillin G 2.4 million units IM once per week x 3 weeks


  1. high risk groups
  2. in pregnancy


GYNCOLOGICAL STDs Part 03 GYNCOLOGICAL STDs Part 03 Reviewed by Radiology Madeeasy on August 24, 2010 Rating: 5
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