title: Clinical characteristics of hypertrophic herpes simplex genitalis and treatment outcomes of imiquimod: a retrospective observational study.
abstract: OBJECTIVE
  Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection.
  
  
  METHODS
  The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively.
  
  
  RESULTS
  Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy.
  
  
  CONCLUSIONS
  Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand. Electronic address: charussrilee@gmail.com.
authors: Charussri
authors: C
authors: Leeyaphan
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
authors: Theetat M
authors: TM
authors: Surawan
authors: Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Tiwanon Road, Nonthaburi, Thailand.
authors: Pornchai
authors: P
authors: Chirachanakul
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
authors: Nuntida
authors: N
authors: Prasertworonun
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
authors: Praewphan
authors: P
authors: Punyaratabandhu
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
authors: Viboon
authors: V
authors: Omcharoen
authors: Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
authors: Sukhum
authors: S
authors: Jiamton
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000634:Aminoquinolines / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D060085:Coinfection; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications; D006558:Herpes Genitalis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014456:Ulcer / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000998:Antiviral Agents; D000077271:Imiquimod; D000212:Acyclovir
keywords: Atypical manifestation; HIV infection; Herpes simplex genitalis; Hypertrophic type; Imiquimod