Slide 4
Primary anogenital herpes

This woman has primary anogenital herpes due to HSV-2. The patient was systemically unwell with fever, myalgia and meningism for 5 days prior to presentation. At the time of presentation she had bilateral vulval oedema and extensive genital and anal ulceration. She was in acute urinary retention with a palpable bladder. She was admitted for suprapubic catheterization and prompt commencement of antiviral therapy, analgesia and bed rest. The catheter was initially clamped and, after 96 hours, could be successfully removed whereupon she commenced micturition acceptably again. In certain cases, urinary retention is due to voluntary holding back of voiding because of the severe pain which patients suffer when concentrated urine washes across vulval and vaginal ulcers. Sometimes this can be ameliorated by asking the patient to urinate in a warm saline bath. In other cases, there is clearly a neurological component to the urinary retention, which requires more than symptomatic relief and antiviral therapy. Early involvement of an urogynaecologist and the use of therapies to improve bladder function are useful in the management of these complications.