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Author: Admin | 2025-04-28
Relieving pain in immunocompromised patients.29 All patients should abstain from sexual activity in the presence of lesions, including abstinence during the herpes prodrome.1 For maternal HSV, suppressive therapy reduces the risk of active lesions during labor,30 reducing the risk of recurrence by 75% and reducing the rate of cesarean delivery secondary to HSV by 40%.31 Daily oral suppressive medication is effective for preventing recurrence of HSV ulcers. Pericoital application of tenofovir gel may reduce the likelihood of HSV-2 transmission to women but is not currently recommended for suppressive therapy.32 Although viral shedding is reduced by 90% while patients are taking oral suppressants, some risk of transmission still exists.17 Asymptomatic patients with genital HSV-2 still exhibit genital viral shedding up to 10.2% of the time, compared with 20.1% for symptomatic patients.33 In those with symptomatic HSV outbreaks, suppressive therapy should be considered to reduce transmission to seronegative partners.17 Recurrent HSV-1 infection may be slower to heal and more painful for patients who are immunocompromised, such as during cancer treatment.29 Based on the high prevalence of primary and secondary syphilis for men who have sex with men, if the patient presents with a genital ulcer, the CDC recommends presumptive treatment for syphilis after serologic testing has been performed.1 Noninfectious ulcers may be treated with topical treatments such as pastes, gels, sprays, injections, laser, and locally dissolving tablets, many of which are available as over-the-counter therapies, but limited evidence exists for topical prescriptions.34 Extensive genital ulcers may be treated with cool water or saline, topical antimicrobials, topical or oral analgesics, perineal baths, topical or oral anti-inflammatory agents, or cool compresses with over-the-counter Burow solution to decrease surrounding edema, inflammation, and pain.34 In the patient with a persistent ulcer after treatment, consider biopsy of the ulcer to help identify other causes.1 Prevention and Screening The USPSTF recommends screening for syphilis infection for those at risk,35 early screening for syphilis infection in all pregnant women,36 and against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including those who are pregnant.37 The CDC recommends that physicians offer evidence-based counseling on safer sex
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