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Class notes Medicina Interna Infectología Herpes
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Notes from the theoretical classes of Internal Medicine Infectious Diseases with relevant data and the most important for clinical practice
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GENERALIDADES VHS-1 Herpes orolabial (80-90%). Pueden causar
infección genital en 10-20%.
VHS-2 Transmisión sexual: infección genital (70-90%).
Causa infrecuentemente herpes orolabial en 10%.
Herpes genital es un factor de riesgo importante para la
transmisión de VIH.
REACTIVACIÓN VHS
Puede ser:
MANIFESTACIONES CLÍNICAS - Herpes genital sintomático (recurrente)
o Menos severo que el episodio sintomático inicial
o Ya no hay síntomas sistémicos
o Precedidas por hormigueo o picazón.
o Lesiones usualmente unilaterales
o Presentaciones atípicas: fisuras lineales
excoriaciones
o Se resuelven en 5-10 d
- Asintomático
o Se detecta por PCR o cultivo en el 80-90% de lo
VHS-2.
La presentación clínica inicial del herpes genital no
difiere entre el VHS-1 y VHS-2. La reactivación sintomática es más frecuente con VHS-2.
Periodo de incubación: 4-7d
Clínica (2-3 sem) se autolimita
o Lesiones múltiples en genitales usualmente
bilaterales
HERPES NEONATAL
- En VHS-1 mayor riesgo de transmisión vertical.
o Progresan desde eritema pápulas
- Mayor riesgo cuando la madre tiene la primoinfecció
vesículas úlceras dolorosas costras
durante el tercer trimestre.
50% con lesiones genitales reportan:
o Cefalea
o Fiebre, malestar general DIAGNÓSTICO:
o Disuria, Adenomegalias inguinales - Cuadro clínico + Laboratorio (IgG VHS-1, IgG VHS-2)
En la primoinfección herpética hay síntomas generales
en el 50% de los casos.
TRATAMIENTO
Primoinfección:
- Aciclovir 400 mg 3v/d x 7-10d
- Valaciclovir 1g 2v/d x 7-10d
- Famciclovir 250mg 3v/d x 7-10d
Recurrente:
- Aciclovir 400 mg 3v/d x 5d
- Valaciclovir 500 mg 2v/d x 3d
Neonatal (terapia supresiva):
- Aciclovir 400 mg 3v/d
- Valaciclovir 500 mg 2v/d
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