Question A: Many patients infected with HSV-2 either are asymptomatic or else have small lesions on the penile or vulvar skin that go unnoticed. It is important to note that even though these people are asymptomatic, shedding of the virus can still occur. This accounts for transmission of the virus by individuals who have no active genital lesions and often no history of genital herpes. Although genital herpes is not a reportable disease in the United States, it is estimated that there are 1 million new cases each year.
Question B: Prevention can be accomplished by avoiding contact with infected individuals who are expressing lesions. Although this strategy can limit the spread of the disease, it is important to remember that virus is still being shed in asymptomatic individuals and can be transmitted not only via urethral and cervical secretions but also via saliva.
Question C: Several antiviral drugs inhibit HSV, but the most effective and most commonly used is the nucleoside analog acyclovir. This drug inhibits the function of viral DNA polymerase and significantly decreases the duration of a primary infection. If taken daily, it can also suppress recurrent infections. Resistant HSV virions have been recovered from immunocompromised patients who have persistent lesions, and in these cases the drug foscarnet has been effective. In 1996, the FDA approved valacyclovir and famciclovir for the treatment of recurrent genital herpes.
Question A: It is very likely that one of the procedures related to the tummy tuck, was the insertion of a urinary tract catheter. Frequently these catheters give rise to hospital acquired infections of the urethra and urethritis. Because a liquid path connects the urethra to the kidneys, bacteria can move up it to the nephrons.
Question B: The broad spectrum antibiotic destroyed much of the bacterial content of the urinary tract without harming the Candida. Without competition, these organisms grew to large numbers.
Question C: A major concern is that the patient will contract an antibiotic resistant infection, which may hospitalize her for long periods or even kill her. Another serious concern is dehydration which must be attended to immediately.