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Genital herpes is a sexually transmitted infection (STI) caused by two types of Herpes simplex virus (HSV); HSV-1 and HSV-2. HSV-2 causes higher disease severity and more frequent recurrence. It typically presents as a group of vesicles in which transmission occurs. The vesicles then rupture and transform into ulcers with concomitant secondary bacterial infections. As asymptomatic shedding is very common, its prevalence and the probability of horizontal transmission are high. Differential diagnoses include syphilis, chancroid, or other non-STI genital ulcers. Patients presenting with pathognomonic lesions can be clinically diagnosed and can be confirmed using Tzanck smear, the most commonly used bedside diagnostic tool. Serologic tests, like HSV immunoglobulin G and immunoglobulin M, may be used to guide to the tailor-made management. Patients presenting with atypical lesions can be tested using HSV antigen and nucleic acid amplification tests (NAAT). Patients are prescribed with either oral acyclovir, valacyclovir, or famciclovir, which are considered the mainstay treatment. Patients with primary infection and recurrent episodes require different treatment regimens. In pregnant patients and patients with immunocompromised conditions, adjusted doses are given based on specific guidelines. Furthermore, the consideration in treating pregnant women with genital herpes should be based on the stage of disease and the gestational age at acquiring HSV. Vertical transmission can occur during pregnancy, mainly during the intrapartum period. The primary infection with HSV in the third trimester is the most critical period. All patients should also be evaluated for other STIs, such as human immunodeficiency virus infection, syphilis, hepatitis B infection, and hepatitis C infection.
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