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Herpes Vulvitis |
 Herpes Vulvitis
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 A tingling or itching sensation precedes the development of painful
blisters on both sides of the vulva in acute herpes infection. The blisters then break
open, releasing clear fluid, and form shallow ulcers, filled with grayish material. The
ulcers then crust over and when the crusts fall off, the underlying skin looks normal. The
process takes 7-10 days.During the ulcerative stage, the pain may be so intense as to require narcotic analgesia. Urinating during this time can be extremely painful due to the hot, salty urine coming in contact with the open sores on the vulva. The pain may be so intense as to require such measures as urinating into a sitz bath or even placement of an indwelling urinary catheter (Foley). The diagnosis is made by the typical appearance and may be confirmed with a herpes culture. Although this lesion resolves spontaneously, re-occurrences are common. Preferred treatment (CDC) for an initial outbreak is:
Preferred treatment (CDC) for a recurrence is:
Some individuals have frequent recurrences, as often as every several weeks. For these women, "suppressive therapy" can be very helpful. Suppressive therapy involves taking relatively low doses of anti-viral medication daily, in order to keep the virus from causing such frequent attacks. Suggested regimens (CDC) for suppressive therapy include:
Another component of a herpes outbreak can be a bacterial superinfection. During the ulcerative stage, skin bacteria (strep, staph, coliforms) can attack the exposed ulcers, causing a bacterial infection of the ulcer. This is particularly true of large or multiple, confluent ulcers. These women may benefit (faster recovery and less pain) by the use of antibiotics such as amoxicillin, any cephalosporin or erythromycin, even though those drugs will have no effect on the course of the viral component of the herpes.
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