Questions: • Identify the clinical symptoms consistent

Questions: • Identify the clinical symptoms consistent with primary genital herpes infection • Identify three major risk factors for genital herpes in this patient • Discuss treatment options for this patient • What precautions would you advise this patient to take? Patient Case Patient’s Chief Complaints: “I have some very painful blisters near my vagina and I think there may be some inside, too. I felt a strange stinging sensation for a couple days and then broke out. I’ve also had several horrific headaches and muscle aches the past few days—almost like the flu.” HP: Ms. B is a 43 yo nulligravida woman who presents to her OB-GYN for evaluation of genital lesions that have been present for five days. She is single, sexually active with one partner currently, and admits to frequent unprotected vaginal sex. She denies IV drug use, is heterosexual, and, other than high blood pressure and cholesterol, she is aware of no active medical problems. She denies both oral and anal intercourse. PMH: • Turner syndrome with primary amenorrhea, infertility, and hypoestrogenism secondary to ovarian dysgenesis • Recurrent UTIs, most recent 4 months ago • Recurrent vaginal candidiasis, most recent 1 year ago • Hypercholesterolemia x 3 ½ yrs • Gonorrhea x 2, most recent episode 6 yrs ago • Chlamydia x 2, most recent episode 6 yrs ago • Trichomonas vaginalis, 7 yrs ago • HTN x 10 yrs • No previous history of cold sores, fever blisters, or genital herpes simplex FH: • Father alive with HTN for approximately 35 yrs • Mother alive with hypothyroidism for approximately 25 yrs • No history of cancer, heart disease, diabetes, or stroke SH: • Never married, graduated high school • Lives with boyfriend of 6 yrs • Works as a bookkeeper for a pediatrician • Admits to occasional use of alcohol (wine only) • Denies cigarette smoking, use of marijuana, cocaine, and methamphetamines • Admits to having 10-15 different sexual partners in the past 20 yrs VS: BP 155/95 RR 15 rpm and unlabored HT 4’8″ P 75 pbm T 99.2 F WT 128 lbs ROS: All systems negative except for: • + Some malaise with moderately depressed appetite, headaches, and myalgias • Clusters of small vesicular lesions over vulva and labia • Several ruptured vesicles-erythematous and weeping erosions interspersed Specialized Test Results: • Viral culture of genital vesicular fluid: + for HSV-2 • Vulval swab monoclonal stain: + for HSV-2 • Rectal and cervical cultures: – for Neisseria gonorrhoeae and Chlamydia trachomatis

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