Depression. Clinical Aspects of Depression
2007-10-15 10:31:54
Women are at least twice as often get depressed as men, and even women when women are equal, which will not be in my lifetime, they will still have more depression than men. The four somatic symptoms could be any of the above, and I think that some of these everybody is going to be asking about, because most physicians would ask about weight gain, most would ask about sleep. This would come in but here are the things that might not be asked. Particularly this, the feelings of self fitness or of being hard with your self, and a difficulty in focusing. So for instance, it has a diurnal variation and I think it is important. I once knew a writer that, when he was depressed, he could begin to write around midnight but during the day he was really nonfunctional. Thoughts of suicide. That’s a very important one because it’s as if that’s something that people don’t like to ask, and I’ll come back to that later.
This is the female to male risk at the moment. Major depression, dependi
IMPOTENCY AND MALE INFERTILITY (Part 2)
2007-10-12 10:12:25
Then we would rule out other problems of the lower urinary tract which can give rise to the same symptoms as BPH and some relevant tests, if necessary. This is the voiding diary we just talked about and this is the symptom score. These are mainly in the form of seven questions which the patient would circle 1, 2, 3, 4, 5. We then go down the list and calculate the total score. The maximum you can score is 35 which is the worst. So depending upon what symptoms the patient has, then we’ll score.
As an addendum to that symptom score, at the bottom there is a quality of life grading. They would grade their satisfaction to their lifestyle at present, 1, 2, 3, 4, 5 and again the 5 is worst. I also usually look at the this score at the same time as the symptom score itself because that will then give me an idea if the patient has circled 3, he is not happy, he is dissatisfied, 4 would be he is unhappy and 5 is very unhappy with his quality of life. Then we do the grading of the symptom scor
IMPOTENCY AND MALE INFERTILITY
2007-10-12 10:06:28
As a person becomes older, they are over 60 years of age, more than half of the people would have some evidence of benign prostatic enlargement, whether histologically or clinically. When you reach the age of 85 years, almost 90% of people in this country would have benign prostatic enlargement, again, histologically. You can even find evidence histologically of enlargement of this gland in at least 10% of people in the younger age group between 25-30 years.
The histologic evidence of benign prostatic enlargement, even at the age of 30 years. Then it keeps on enlarging and it can become symptomatic, mainly after the age of 50. Similarly, this is also just the prevalence of this gland this slide shows in a graphic fashion in over 1000 autopsies. This is the age range in years here and the number of autopsies done in this particular age group. Again, this is where it just jumps up. What symptoms does benign enlargement of the prostate give you? There are two different types of symptoms.
Erectile Dysfunction (Part 3)
2007-10-11 12:39:08
Physical examination.
Signs of hypogonadism, such as gynecomastia or the loss of axillary and pubic hair, should be noted. The size and consistency of the testes should be noted. The penis should be examined for fibrosis and plaques indicative of Peyronie’s disease. The bulbocavernosus and cremasteric reflexes should be assessed. The bulbocavernosus reflex is elicited by squeezing the glans penis while observing for contraction of the external anal sphincter.
Laboratory tests
A urinalysis, complete blood count and basic chemistry panel will help to rule out most metabolic and renal diseases. In elderly men, thyroid-stimulating hormone level should be measured to rule out thyroid dysfunction. A free testosterone level should be obtained in all men aged 50 and older and in those younger than 50 who have symptoms or signs of hypogonadism (eg, decreased libido, testicular atrophy, reduced amount of body hair).
Sildenafil ( Viagra) inhibits the conversion of cGMP to guanosine monopho
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Erectile Dysfunction (Part 2)
2007-10-11 12:19:21
Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for sexual intercourse. Between the ages of 40 and 70 years, the probability of complete erectile dysfunction triples from 5.1 percent to 15 percent.
Physiology of erection
Penile erection is mediated by the parasympathetic nervous system, which when stimulated causes arterial dilation and relaxation of the cavernosal smooth muscle. The increased blood flow into the corpora cavernosa in association with reduced venous outflow results in penile rigidity.
Nitric oxide is a chemical mediator of erection. This substance is released from nerve endings and vascular endothelium, causing smooth muscle relaxation, resulting in venous engorgement and penile tumescence.
History and physical examination
The history should include the frequency and duration of symptoms, the presence or absence of morning erections, and the quality of the relationship with the sexual partner. The sudden onse
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Erectile dysfunction(Impotence)
2007-10-09 11:17:05
Erectile dysfunction
(Impotence
) is a sexual frustration as a result of which the man cannot reach and-or support a sexual member, sufficient for fulfilment of the sexual certificate. The impotence is not connected directly with ability to eaculation. There are many reasons of an impotence, for example a diabetes. Some reasons of an impotence are irreversible. As impotense - the phenomenon of delicate character, it made long time some kind of табу and has served as a subject of many city legends. From the middle of 30th years, national means from an impotence have started to be advertised widely. In 90th years, with the invention of Viagra, interest to a subject of an impotence and its treatment has increased, substantially owing to active advertising of a new preparation.
GENERALIZED ANXIETY DISORDER
2007-10-19 11:15:04
The DSM-IV identifies the principle characteristic of generalized anxiety disorder as excessive anxiety and worry, usually, over a period of greater than 6 months. The concerns are considered to be far out of proportion to reality. The anxiety is accompanied by at least three of the following symptoms: restlessness, easy fatiguability, difficulty concentrating, muscle tension, irritability, and sleep disturbance. The symptoms are sufficiently severe to interfere with the person’s life style, and are not attributable to another mental disorder or drugs.
In primary care, patients with GAD often present to their physicians with a cluster of autonomic symptoms, such as:
Cardiac (chest pains, palpitations, tachycardia, tachypnea)
Pulmonary (hyperventilation, smothering sensations, dyspnea)
Gastrointestinal (globus hystericus, indigestion, abdominal pains, flatulance, diarrhea, constipation)
Genitourinary (frequency, menstrual irregularities, sexual dysfunction)
Dermatologic (paresthes
Insomnia.
2007-10-17 08:43:59
Insomnia is the perception by patients that their sleep is inadequate or abnormal. Insomnia may affect as many as 69% of adult primary care patients. The incidence of sleep problems increases with age. Younger persons are apt to have trouble falling asleep, whereas older persons tend to have prolonged awakenings during the night.
Causes of insomnia
Situational stress concerning job loss or problems often disrupt sleep. Patients under stress may experience interference with sleep onset and early morning awakening. Attempting to sleep in a new place, changes in time zones, or changing bedtimes due to shift work may interfere with sleep.
Drugs associated with insomnia include antihypertensives, caffeine, diuretics, oral contraceptives, phenytoin, selective serotonin reuptake inhibitors, protriptyline, corticosteroids, stimulants, theophylline, and thyroid hormone.
Psychiatric disorders. Depression is a common cause of poor sleep, often characterized by early morning awakening. Associated
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Erectile Dysfunction
2007-10-24 11:17:08
Definition of Erectile Dysfunction
(ED):
“The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance” (NIH Consensus Development Panel on Impotence)
Prevalence of ED
-Approximately 5% of men at age 40, increasing to 15% - 25% by age 65
-Massachusetts Male Aging Study (community based survey of men 40-70 years) - 52% of all respondents reported some degree of ED
-Prevalence increases with age, but ED is not an inevitable and untreatable consequence of aging
ED and Quality of Life
-ED reduces quality of life
-ED may be associated with
Depression
Loss of self-esteem
Poor self-image
Increased anxiety with one’s sexual partner
Relevance of Sexual Health Issues to Primary Care
-Sexual health important to overall health
ED may signal serious underlying disease, eg:
Diabetes
Hypertension
Cardiovascular diseasePeripheral vascular diseaseNeurologic disorders
Questions on sexual function should be part of medical history/physical exam
Antibiotics. Ampicillin. Amoxicillin.
2007-10-24 09:53:18
Ampicillin is a drug that has a fairly broad spectrum. We typically use this for infections where H. flu or E. coli are likely pathogens. Obviously beta-lactamase production is somewhat limiting the utility of this drug in those cases but it still is a useful drug in many cases of infections like that. The problems are diarrhea. When you give it orally, a fair proportion of the patients will develop this – 10 to 20%. Rash is two-fold. You, no doubt, have run into lots of ampicillin rashes in your practice but just to remind you, about 3% of patients will develop a rash within 24 hours which is urticarial or hive-like. When that occurs, that is an allergic reaction to ampicillin and the patient should be considered penicillin allergic.
On the other hand, three to seven days out usually, the patient may develop a rash that is maculopapular or is described as a fine red rash or a measles-like rash. It typically starts on the trunk, spreads peripherally and it doesn’t itch much. Th
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Weight loss medications
2007-10-23 10:36:50
Weight loss medications
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Lipotrexate - Lipotrexate is one of the safest and most powerful dietary supplements on the market. Its special proprietary blend of pharmaceutical grade botanicals provides you with consistent levels of sustained energy all day without the nervous
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Obesity
2007-10-23 08:09:56
Obesity is defined as a body mass index (BMI) of 30 kg per m2 or more. Overweight is defined as a BMI of 25 to 29.9 kg per m2. About 35 percent of American adults (aged 20 years of age or older) are overweight. In addition, 14 percent of children between the ages of 6 and 11, and 12 percent of adolescents between the ages of 12 and 17 are overweight.
Weight loss medications at Canadian Online Pharmacy.
Pathophysiology. The adipocyte has endocrine capabilities and secretes leptin — a protein product of the ob gene — in response to increased stores of energy. Leptin limits food intake by acting upon the OB receptor in the hypothalamus. In many obese adults, leptin levels are increased, whereas leptin uptake into the central nervous system is low.
Diagnosis of obesity begins with the determination of BMI. The BMI can be ascertained by measuring the patient’s height and weight and then using a BMI table to find the BMI value.
Nutrition therapy
A meal plan that creat
Sexual Dysfunction (Part 4)
2007-10-22 08:18:03
Medical Factors in Evaluation
The Urological evaluation
Vascular - Nocturnal penile tumescence/postage stamp test
Nervous
Hormonal - Testosterone/FSH/LH/Thyroid
Women
Physical examination - Muscle spasm/pain/
Menopausal issues - Hormone assessment/Testosterone levels
Treatment Approach
Joint and individual meetings
Family and sexual history
Sharing the ideas — the point of “collaboration”
Integrating Approach
Behavioral/psychodynamic/cognitive
Creating a safe climate Providing a model for discussion Being a resource for information Suggesting books
Specific assignments — the Sensate Focus model looking at what happens with that
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Sexual Dysfunction (Part 3)
2007-10-22 08:08:20
Evaluation of Sexual
Dysfunctions
Need to assess
Intrapsychic
Interpersonal
Medical/organic
At our licensed canadian pharmacy You can order viagra online
Asking about Sex
We have had no models for talking about it
No training - medical schools and residencies still ignore it
Mixed messages on the media — open, explicit shame - censored
Cross generational awkwardness
Often the sexual interaction provides enormous information about the couples dynamics and vulnerabilities.
Power struggles
Issues around being given to — receiving
Being able to identify what they want
Tell me about your sexual relationship
Are you Satisfied
Would you want anything to be different
How long has this been an issue
Does anything make it better/worse
What is your “formulation” about the cause
What has sex been like with other partners
Frame it - “There are some specific questions I would like to ask…” Patterns of initiation Fantasies
Experimentation — readin
Sexual Dysfunction (Part 2)
2007-10-22 08:01:12
Women
5% of women do not have orgasms under any circumstances
40% of women do not have orgasm with intercourse
Increased awareness that intercourse may provide insufficient stimulation for orgasm
SSRIs may inhibit orgasm and sexual desire (80%)
Using Bupropion (Wellbutrin) may counteract SSRI
Desire phase problems [30- 50% of couples]
The most prevalent
Not amenable to the directed approach
No unified hypothesis about it
High expectations from the media - magazines etc,
Pose a dilemma for the therapist
People often do not get better
“Affairs’” may confuse this picture
Etiology
Intimacy/closeness conflict
Depression
Medications
Medical - Chronic illness/hormonal
Paraphilic preoccupations
Does the individual have sexual fantasies about someone else and does he/she masturbate ?
Mixed patterns (Reciprocal patterns - eg, vaginismus/premature ejaculation)
Pain
Vulvovestibulitis
Vaginismus
Deep dyspareunia
Paraphilias [5%]
DSM IV “A group of disorders whose essential f
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Sexual Dysfunction
2007-10-22 08:01:10
Sex Therapy
Mixed messages in the culture
Apparent openness in the media
Few models for adult to adult discussion about sexual issues
Current of prohibition and sex negative values persist
Sex education in the school under siege
Medical schools provide very little
The Sexual
Dysfunctions
Large numbers (Recent survey indicates 40%)
People often believe that they are the only failures
Enter a conspiracy of silence
Almost always around as an issue - jokes, movies
Sense of shame/blame/inadequacy
(The relief in the therapist clarifying it )
To whom do they go — MDs are often more uncomfortable
Arousal disorders [10%]
Men
Erectile difficulties in men
Cycle of performance anxiety
Increased awareness of physical components
Women
Inability to maintain adequate vaginal lubrication
Intercourse painful or uncomfortable
May choose to keep problem hidden from partner
Performance anxiety often not considered in women
Etiology
Psychogenic
Medications
Depression
Vascular disease
Hormonal
Neurolog
Antidepressants
2007-10-29 08:37:51
Alternative applications of “antidepressants”
Although the evidence of efficacy of antidepressants, as a class, is not as convincing as for other types of drugs, there is growing clinical and research evidence to support a widening range of potential indications of these drugs. The partial success of the SSRIs as a group in ameliorating
OCD is encouraging, as is the utility of TCAs (especially imipramine) and MAO inhibitors (less so fluoxetine, not bupropion) in blocking the episodic, acute autonomic expression of panic. The range of disorders suspected of being related to OCD and in which serotonin-enhancing treatments are being explored, includes eating disorders, hair-pulling (trichotillomania) and other repetitive habits, compulsive gambling, kleptomania, premenstrual dysphoria, and perhaps body dysmorphic disorder. Antidepressants have a scientifically demonstrated but incompletely defined place in the overall management of patients with bulimia nervosa and may have an
Dosing of antidepressants. Treatment-resistance
2007-10-29 08:31:42
Treatment-resistance
The problem of apparent “treatment-resistance” in depression requires further study, but many cases respond when a patient actually is willing to follow a previously recommended treatment, or high doses are accepted and pursued for at least 6-8 weeks. Some cases may represent destabilizing effects of overly aggressive antidepressant treatment of patients with overlooked bipolarity, but many others are truly treatment-unresponsive unipolar depressions. In cases of convincing treatment resistance, or loss of response over time (tolerance), evidence that important gains are to be found in exploring a series of similar agents is lacking. It may be useful to try an agent of a dissimilar type, and the most encouraging experience has been reported in adding lithium (while considering previously overlooked, subtle bipolarity and even use of mood-stabilizer therapy alone), changing from a TCA to an MAO inhibitor, or use of ECT (especially in severe, psychotic, o
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, Treatment
Clinical Pharmacology of Antidepressants
2007-10-29 08:28:26
Antidepressants
Types of antidepressants
Antidepressants currently fall into five major categories: [1] tertiary amine tricyclics (amitriptyline, clomipramine, doxepin, imipramine, trimipramine), secondary amine tricyclics (amoxapine, desipramine, maprotiline, nortriptyline, protriptyline); [2] monoamine oxidase (MAO) inhibitors (phenelzine, tranylcypromine, selegiline [(-)-deprenyl], and experimental short-acting MAO-A inhibitors (eg,, moclobemide [Manerex], marketed in Canada); [3] serotonin-reuptake inhibitors: (SSRIs) clomipramine, citalopram, [±]-fluoxetine, fluvoxamine, sertraline, paroxetine, and the mixed 5-HT/NE uptake inhibitor venlafaxine (plus the withdrawn zimelidine; [4] stimulant-like dopaminergic as well as noradrenergic agents: bupropion (and the withdrawn nomifensine); [5] the atypical antidepressant mirtazapine (Remeron; a sedating antidepressant chemically related to mianserin, with indirect adrenergic and serotonergic actions as an a2 and serotonin 5-HT2 and 5-HT3
Postherpetic Neuralgia. Medications.
2007-11-01 11:23:39
Analgesics
Capsaicin (Zostrix-HP), an extract from hot chili peppers, is more efficacious for post-herpetic neuralgia than placebo. Capsaicin cream must be applied to the affected area three to five times daily.
Lidocaine patches reduce pain intensity, with minimal systemic absorption. The effect lasts only four to 12 hours with each application.
Acetaminophen (eg, Tylenol) and nonsteroidal anti-inflammatory drugs are useful for potentiating the pain-relieving effects of other agents.
Tricyclic antidepressants that are commonly used in the treatment of postherpetic neuralgia include amitriptyline Elavil, nortriptyline (Pamelor), imipramine (Tofranil) and desipramine (Norpramin).
Anticonvulsants. Phenytoin Dilantin carbamazepine (Tegretol) and gabapentin Neurontin are often used to control neuropathic pain.
Other modalities used to treat post-herpetic neuralgia include transcutaneous electric nerve stimulation (TENS), biofeedback and nerve blocks.
Herpes Treatment. Anti-Herpes Medications.
2007-11-01 11:08:17
Treatment of herpes zoster
Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash. Benefits have been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash.
Acyclovir Zovirax therapy appears to produce a moderate reduction in the development of postherpetic neuralgia. Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir.
Valtrex, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia.
Famvir The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir.
All three antiviral
Read more: Treatment
Herpes
2007-11-01 10:45:14
Herpes zoster (shingles) results from reactivation of the varicella-zoster virus. Herpes zoster is a sporadic disease with an estimated lifetime incidence of 10 to 20 percent. The incidence of herpes zoster increases sharply with advancing age, roughly doubling in each decade past the age of 50 years. Herpes zoster is uncommon in persons less than 15 years old.
Pathophysiology
Varicella-zoster virus is a highly contagious DNA virus. Varicella represents the primary infection in the nonimmune person. During the primary infection, the virus gains entry into the sensory dorsal root ganglia, where the virus remains latent for decades. Reactivation of the virus occurs following a decrease in virus-specific cell-mediated immunity. The reactivated virus causes a dermatomal distribution of pain and skin lesions.
Although herpes zoster is not as contagious as the primary varicella infection, persons with reactivated infection can transmit varicella-zoster virus to nonimmune contacts. About 20 p
Antibiotics. Azlocillin. Oral oxacillin.
2007-10-31 11:22:51
Azlocillin is like piperacillin in its spectrum and its uses. It basically is essentially as good as piperacillin and I would suggest that whichever one you use depends on which one your institution can get the least expensively. You do not need to have both azlocillin and piperacillin in a given hospital.
Penicillin H resistant penicillins are useful for Staph aureus infections. That is essentially the only reason that these should be used because they are significantly more expensive and more toxic for other uses. Therefore, they should be limited to treatment of suspected or proven Staph aureus. These should not be used for methicillin resistant Staph aureus and I might point out that methicillin resistant Staph aureus is a misnomer. These are not only methicillin resistant, they are also beta-lactam resistant, so they are unlikely to be susceptible to any of the penicillins or the cephalosporins.
One other thing that you need to consider when you are prescribing these products is t
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Antibiotics. Ticarcillin. Carbenicillin.
2007-10-30 17:26:40
Ticarcillin is also a penicillin derivative but its major activity, rather than being Gram positive, is Pseudomonas. That is the principal use of ticarcillin. We give it IV in large doses. It is impractical to give this product IM. It contains about 5 milliequivalents of sodium per gram and we give big doses. So we potentially could be running the equivalent of two-thirds or a full liter of normal saline into our patient with the sodium content of this product. So you can get into sodium overload problems. You can also, in patients who are predisposed to bleeding, run into problems with this because it can interfere with platelet adhesiveness and directly with the coagulation sequence. In most normal patients that is not a concern but if you have someone with a preexisting severe nutritional deficiency or coagulopathy, you probably should be careful about using this particular product.
Carbenicillin indanyl sodium used to be available parenterally. It is no longer available that way. I
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Antibiotics. Penicillin.
2007-10-30 09:02:02
Penicillin resistant Pneumococcus and other bacterial resistance have become a rapidly increasing problems. So we have to be careful with the way we use antibiotics as we do any other drug. Some resistant mechanisms work by competitive antagonism. The sulfas are folic acid synthesis inhibitors. Those bacteria that are obligate folate synthesizers are inhibited because there are non-utilizable forms of folate that are synthesized when the sulfas are present. Some others are cell wall inhibitors. For example, penicillins and cephalosporins will cause defects in the formation of the cell walls. Essentially it’s like taking the cement out from between the bricks. The cell membrane may, too, be interfered with. The antifungals very often will align themselves between the lipid and protein complexes and interfere with the metabolic functions of the cell membrane in fungi. Some will inhibit protein synthesis. For example, erythromycin, tetracycline and chloramphenicol will basically sto
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What are the possible side effects of VALTREX?
2007-11-07 11:51:15
Kidney failure and nervous system problems are not common, but can be serious in some patients taking VALTREX. Nervous system problems include aggressive behavior, unsteady movement, shaky movements, confusion, speech problems, hallucinations (seeing or hearing things that are really not there), seizures, and coma. Kidney failure and nervous system problems have happened in patients who already have kidney disease and in elderly patients whose kidneys do not work well due to age. Always tell your healthcare provider if you have kidney problems before taking VALTREX. Call your doctor right away if you get a nervous system problem while you are taking VALTREX.
Common side effects of VALTREX include headache, nausea, stomach pain, vomiting, and dizziness. Side effects in HIV-infected adults include headache, tiredness and rush. These side effects are usually mild and usually do not cause patients to stop taking VALTREX.
Other less common side effects include painful periods in women, join
HERPES SIMPLEX VIRUS 3
2007-11-07 10:57:22
Valtrex (VACV) is a 1-valyl ester of ACV. This drug has a five times greater bioavailability than oral ACV, reaching plasma levels of ACV similar to the level attained with intravenous ACV. Oral VACV was FDA-approved at a dose of 1000 mg three times per day for 7 days for the treatment of acute herpes zoster. This therapy was as safe as oral ACV but was more convenient than oral ACV and more effective in terms of zoster-associated pain. In direct comparison with ACV, treatment with VACV decreased the proportion of patients with pain at 6 months, whereas no differences were found between FCV and ACV treatment in the time for pain to disappear or in the incidence of PHN. VACV is approved for the episodic treatment of recurrent genital herpes at a dose of 500 mg twice a day for 5 days, and for therapy of first episode genital herpes at a dose of 1000 mg twice daily for 10 days. Recently, VACV at 500 mg once daily was approved for suppression of recurrent genital herpes. In all three situ
HERPES SIMPLEX VIRUS 2
2007-11-06 23:58:43
The treatment of acute herpes zoster requires acyclovir 800 mg orally to be given five times per day for 7 to 10 days. Acyclovir has also been shown to reduce the duration of symptoms of postherpetic neuralgia from 62 days for patients treated with placebo to 20 days for patients treated with acyclovir. One prospective cohort of 14,858 patients treated with oral acyclovir found a 3-month PHN incidence of 2.1%, lower than that for historical controls.
In addition to the oral form, ACV is also available in a topical as well as an intravenous preparation. Topical ACV continues to be used for therapy of HSV regardless of its low efficacy in that form. In immunocompromised patients with HSV or VZV, especially with disseminated disease, as well as in immunocompetent persons with severe trigeminal (especially ophthalmic) zoster, the intravenous form of ACV is preferred. This is because the efficacy of acyclovir is limited, owing to a 15% to 20% bioavailability when taken orally.
Because of th
HERPES SIMPLEX VIRUS
2007-11-05 07:21:47
HERPES SIMPLEX VIRUS AND OTHER HUMAN HERPES VIRUSES
The human herpes viruses (HHV) are double-stranded linear DNA viruses that cause a variety of different cutaneous manifestations. Included in the herpes family are herpes simplex virus type 1 and type 2, known to cause cold sores and genital lesions, respectively, although both types of lesions can be caused by either virus. These two subtypes have also been known to cause gingivostomatitis, herpes gladiatorum, eczema herpeticum, herpes whitlow, neonatal herpes, lumbosacral herpes, herpetic keratoconjunctivitis, herpes encephalitis, and cervicitis, and are a leading cause of erythema multiforme. Human herpes virus type 3 (varicella zoster) presents in its primary form as chickenpox, and in a recurrent form as herpes zoster or shingles. Epstein-Barr virus (EBV) (HHV4) is commonly known to cause infectious mononucleosis. Human herpes virus type 5 is more commonly known as cytomegalovirus (CMV) and is the leading cause of blindness in AI
Orolabial herpes
2007-11-08 13:44:24
Orolabial herpes (gingivostomatitis) is the most prevalent form of mucocutaneous herpes infection; 35 to 60 percent of persons in the United States show serologic evidence of having been infected by HSV-1. Overall, the highest rate of infection occurs during the preschool years. Female gender, history of sexually transmitted diseases and multiple sexual partners are risk factors.
Clinical presentation
Primary herpetic gingivostomatitis usually affects children under the age of five. It typically takes the form of painful vesicles and ulcerative erosions on the tongue, palate, gingiva, buccal mucosa and lips. Edema, halitosis and drooling may be present, and tender submandibular or cervical lymphadenopathy is common.
Systemic symptoms include fever (38.4 to 40E°C [101 to 104E°F]), malaise and myalgia. The duration of the illness is two to three weeks, and oral shedding of virus may continue for as long as 23 days.
Recurrences typically occur two or three times a year. The duration is
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