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Suppressive therapy of recurrent genital herpes is a challenge, and melatonin may be an alternative. OBJECTIVE: To evaluate the action of melatonin, acyclovir, or the association of melatonin with acyclovir as a suppressive treatment in women with recurrent genital herpes. DESIGN: The study was prospective, double-blind, and randomized, including 56 patients as follows: (a) The melatonin group received 180 placebo capsules in the 'day' container and 180 melatonin 3 mg capsules in the 'night' container (n = 19); (b) The acyclovir group received 360 capsules of 400 mg acyclovir twice a day (one capsule during the day and another during the night) (n = 15); (c) the melatonin group received 180 placebo capsules in the 'day' container and 180 melatonin 3 mg capsules in the 'night' container (n = 22). The length of treatment was six months. The follow-up after treatment was six months. Patients were evaluated before, during, and after treatment through clinical visits, laboratory tests, and the application of four questionnaires (QSF-36, Beck, Epworth, VAS, and LANNS). RESULTS: No statistically significant difference was observed for the depression and sleepiness questionnaires. However, in the Lanns scale for pain, all groups decreased the mean and median values in time (p = 0.001), without differentiation among the groups (p = 0.188). The recurrence rates of genital herpes within 60 days after treatment were 15.8%, 33.3%, and 36.4% in the melatonin, acyclovir, and association of melatonin with acyclovir groups, respectively. CONCLUSION: Our data suggest that melatonin may be an option for the suppressive treatment of recurrent genital herpes.

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Herpes viruses are widespread in the human population and can cause many different diseases. Genital herpes is common and can increase the risk of HIV infection and neonatal herpes. Acyclovir is the most used drug for herpes treatment; however, it presents some disadvantages due to its poor oral bioavailability. In this study, some ethylene vinyl acetate devices with different acyclovir amounts (0, 10, and 20 wt.%) were manufactured by fused filament fabrication in two different geometries, an intrauterine device, and an intravaginal ring. Thermal analyses suggested that the crystallinity of EVA decreased up to 8% for the sample loaded with 20 wt.% of acyclovir. DSC, SEM, and FTIR analyses confirmed that the drug was successfully incorporated into the EVA matrix. Moreover, the drug release tests suggested a burst release during the first 24 h followed by a slower release rate sustained up to 80 days. Biological assays showed the biocompatibility of the EVA/ACV device, as well as a 99% reduction in vitro replication of HSV-1. Finally, the EVA presented a suitable performance for 3D printing manufacturing that can contribute to developing personalized solutions for long-term herpes treatment.

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Introducción: Las infecciones de transmisión sexual constituyen un relevante problema de salud a nivel mundial; particularmente afectan la salud sexual de las mujeres ocasionando dolencias y efectos muy negativos, como la infertilidad, los embarazos ectópicos y el cáncer cervicouterino. Objetivo: Describir las características epidemiológicas de las infecciones de transmisión sexual relevantes en mujeres de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo en la provincia de Santiago de Cuba de la población femenina que presentó infecciones de transmisión sexual durante el período 2007-2017, detallando cada afección según año, municipio, edad, entre otras variables de interés. Asimismo, se analizaron la frecuencia, las tasas de incidencia, las tendencias y las variaciones temporales. Resultados: Las entidades clínicas predominantes fueron el síndrome de dolor pélvico y la secreción vaginal, en tanto, las menos frecuentes resultaron ser el herpes genital y la blenorragia. En el análisis por cada tipo de infección se observó una mayor afectación en féminas de edades jóvenes. Conclusiones: Las infecciones de transmisión sexual constituyen un serio problema de salud en mujeres de la provincia de Santiago de Cuba, que deviene causa importante de embarazos ectópicos y esterilidad. Sin embargo, se debe mejorar la vigilancia epidemiológica de estas enfermedades, pues existe un marcado subregistro de algunas y, por ende, una inadecuada atención, sobre todo en el sexo femenino.

Introduction: Sexually transmitted infections constitute an outstanding health problem worldwide; they particularly affect the sexual health of women causing ailments and very negative effects as infertility, ectopic pregnancies and cervical uterine cancer. Objective: To describe the epidemiologic characteristics of the outstanding sexually transmitted infections in women from Santiago de Cuba. Methods: A descriptive and retrospective study was carried out in the province of Santiago de Cuba in the female population that presented sexually transmitted infections during 2007-2017, with details of each affection according to year, municipality, age, among other variables of interest. Also, frequency, rates of incidence, tendencies and temporary variations were analyzed. Results: The predominant clinical entities were the pelvic pain syndrome and vaginal secretion, as long as, the less frequent were genital herpes and blennorrhagia. In the analysis for each type of infection a higher affectation was observed in young females. Conclusions: Sexually transmitted infections constitute a serious health problem in women from the province of Santiago de Cuba that becomes important cause of ectopic pregnancies and sterility. However, the epidemiologic surveillance of these diseases should be improved, because there is a marked subrecord of some of them and, therefore, an inadequate care, mainly in the female sex.

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RESUMEN Objetivo Determinar la prevalencia de Chlamydia trachomatis (CT), virus herpes simple-2 (VHS-2) y N. gonorrhoeae (NG) y los factores de riesgo relacionados con la infección, en un grupo de estudiantes universitarios de la ciudad de Medellín. Metodología Se realizó un estudio descriptivo en un grupo de 323 estudiantes universitarios. A través de un formulario en línea, se realizó el reporte de los factores de riesgo y síntomas relacionados con infecciones de transmisión sexual (ITS) y luego se determinó la presencia de anticuerpos IgG y IgM para CT y VHS-2 y se realizó una prueba de PCR-RT para detectar NG y CT. Resultados La frecuencia de IgG para CT fue del 13% y la positividad para IgM fue del 11,9%. La frecuencia de IgG para VHS-2 fue del 11,8% y la frecuencia de CT y NG por la prueba PCR-RT fue del 1,5% y del 0%, respectivamente. Los factores de riesgo más frecuentes fueron: vida sexual activa en el 96,9%, uso algunas veces o nunca del condón en un 75,2%. Reportaron que tenían secreción genital el 13,6% de los estudiantes; úlceras, el 2,8%; verrugas, el 5,3%; ardor al orinar, el 15,5%; ampollas, el 4,6%, y diagnóstico previo de una ITS, el 18,9% de los estudiantes. Conclusión Se encontró CT y VHS-2 entre los jóvenes estudiados y además una alta frecuencia de factores de riesgo para la adquisición de ITS. Se recomienda mejorar las campañas de prevención y diagnóstico de las ITS en los jóvenes universitarios.

ABSTRACT Objective The aim of this study was to determine the prevalence of Chlamydia trachomatis (CT), Herpes Simple-2 virus (HSV-2) and N. gonorrhoeae (NG), and the risk factors related to the infection in a group of college students in the city of Medellín, Colombia. Methods A descriptive study was carried out in a group of 323 university students. Through an online form, the risk factors and symptoms related to sexually transmitted infection (STI) were reported, and then the presence of IgG and IgM antibodies for CT and HSV-2 was determined, and RT-PCR testing was performed to detect NG and CT. Results 13% was the IgG frequency for CT while 11.9% was for IgM. The frequency for IgG for VHS-2 was 11.8 while the frequencies determined by RT-PCR for CT and NG were 1.5% and 0.0% respectively. The risk factors most commonly associated were active sex life, 96.9%, and random use of condom, 75.2%. It was also found that 13.6% of the students had genital secretions, 2.8% had ulcers, 5.3% had genital warts, 4.6% had blisters, 15.5% had dysuria, and 18.9% had a previous STI diagnosis. Conclusions CT and HVS-2 were found among college students, besides a series of risk factors associated with STI. It is recomended to improve prevention and diagnosis campaigns among young college students.

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Úlceras genitais são manifestações clínicas de etiologias diversas, o que pode dificultar o diagnóstico. Este relato de caso trata­se de mulher de 64 anos, com histórico de úlcera genital dolorosa há 4 meses, progressiva apesar do uso prévio de antiviral. Apresentava lesão ulcerada com comprometimento perianal. Histopatológico revelou neovascularização, edema e infiltrado inflamatório. Realizou tratamento com aciclovir endovenoso por 14 dias, com melhora parcial. O herpes simples crônico manifesta­se como verruga ou úlcera de pelo menos um mês, geralmente em imunossuprimidas. A resistência a agentes antivirais é uma complicação encontrada, mas a resposta ao tratamento costuma ser mais lenta do que nas infecções comuns.

Genital ulcers are clinical manifestations of diverse etiologies, which can make diagnosis difficult. This case report is about a 64­year­old woman with a history of progressive genital ulcer pain for 4 months, despite prior antiviral use. The ulcerated lesion showed perianal involvement. Histopathology revealed neovascularization, edema and inflammatory infiltrate. Despite the use of intravenous acyclovir for 14 days, the improvement was partial. Chronic herpes simplex reveals wart or ulcer of at least one month, usually in immunosuppressed patients. A resistance to antiviral agents is a complication factor, but the treatment response to common infections is usually slower.

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INTRODUCTION: Understanding the variability in circulating herpes simplex virus type 2 (HSV-2) genomic sequences is critical to the development of HSV-2 vaccines. METHODS: Genital lesion swabs containing ≥ 107log10 copies HSV DNA collected from Africa, the USA, and South America underwent next-generation sequencing, followed by K-mer based filtering and de novo genomic assembly. Sites of heterogeneity within coding regions in unique long and unique short (UL_US) regions were identified. Phylogenetic trees were created using maximum likelihood reconstruction. RESULTS: Among 46 samples from 38 persons, 1468 intragenic base-pair substitutions were identified. The maximum nucleotide distance between strains for concatenated UL_US segments was 0.4%. Phylogeny did not reveal geographic clustering. The most variable proteins had non-synonymous mutations in < 3% of amino acids. CONCLUSIONS: Unenriched HSV-2 DNA can undergo next-generation sequencing to identify intragenic variability. The use of clinical swabs for sequencing expands the information that can be gathered directly from these specimens.

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Introducción: las infecciones de transmisión sexual constituyen un grupo heterogéneo de infecciones transmisibles que han adquirido una extrema importancia para la salud pública en todo el mundo, dada su magnitud, trascendencia y repercusión para el paciente, la familia y la sociedad. Afectan todos los niveles sociales y económicos, a casi todos los grupos de edades, con mayor frecuencia a los adultos jóvenes.Objetivos: revisión y actualización de las infecciones de transmisión sexual más frecuentes en la Atención Primaria de Salud –tema que en este nivel de atención ha sido poco abordadoy con ello, elevar el nivel de conocimientos sobre estas infecciones para lograr un manejo adecuado de su prevención y tratamiento. Método: búsqueda automatizada de los últimos cinco años de artículos electrónicos en bases de datos y textos impresos, libros y folletos; y se efectuó intercambio con especialistas que trabajan estas enfermedades. Se excluyeron los artículos no pertinentes completamente al tema. Resultados: las infecciones de transmisión sexual clásicas curables incluyen: Sífilis, Blenorragia, Chancro blando, Linfogranuloma venéreo, Granuloma inguinal, Uretritis no gonocócica y Trichomoniasis. Existen otras curables, no consideradas como clásicas. Ellas son, la Escabiosis, la Pediculosis pubis, la Candidiasis, el Parasitismo intestinal, la Dermatomitosis, el Molusco contagioso y la Vaginosis bacteriana. Dentro de las incurables se encuentran: VIH/sida, Herpes simple genital, Verrugas genitales (Condilomas Acuminados), la Hepatitis B. Conclusiones: es de suma importancia el conocimiento de estas infecciones y de todos los elementos relacionados con ellas, en aras de prevenirlas(AU)

Introduction: sexually transmitted infections are a heterogeneous group of transmissible infections, which have become extremely important for public health worldwide, given its size, significance and impact for the patient, the family and society. They affect all social and economic levels, to almost all age groups, most often young adults. Objectives and Methods: The researchers set a review and update of the subject, realized by the method of automated search electronic of items in databases and printed texts, books and brochures of the last five years; and exchange took place with specialists working in the area. Not relevant completely to the subject articles were excluded. Results: classic curable sexually transmitted infections include: Syphilis, Gonorrhea, Chancroid, lymphogranuloma venereum, granuloma inguinale, non-gonococcal urethritis and trichomoniasis. There are other curable and not considered classics. They are the Scabies, Pediculosis pubis, Candidiasis, the intestinal parasitism, the Dermatomitosis, the Molluscum Contagiosum and bacterial vaginosis. Incurable STDs include: HIV/AIDS, genital Herpes simplex, genital warts (condylomata acuminata), Hepatitis B. Conclusions: It is of utmost importance to understand these infections and all items related to them, in order to prevent them(AU)

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O Herpes Genital é uma Doença Sexualmente Trans- missível (DST), que acomete milhares de pessoas, sendo considerada um problema de saúde pública, no Brasil. A Abordagem Sindrômica é uma ferramenta importan- te para a realização do diagnóstico precoce e tratamen- to, sendo utilizada pelo enfermeiro, durante a Consulta de Enfermagem, na Atenção Primária à Saúde (APS). Os objetivos foram destacar a atuação do enfermeiro no diag- nóstico e no tratamento do Herpes Genital, enfatizar o uso da Abordagem Sindrômica e destacar a importância da Consulta de Enfermagem para a aplicação dessa Abor- dagem. Trata-se de uma pesquisa de revisão bibliográfica. Concluiu-se que interromper a cadeia de transmissão, as- sim como desenvolver estratégias de prevenção, tratamen- to e aconselhamento é essencial no acompanhamento do portador do Herpes Genital.

Genital herpes is a sexually transmitted disease (STD) that afflicts thousands of people, and is considered a public health problem in Brazil. The syndromic approach is an important tool for conducting early diagnosis and treatment, being used by the nurse during nursing consultation in Primary Health Care (PHC). The objectives were to highlight the nurse's role in the diagnosis and treatment of genital herpes, emphasize the use of the syndromic approach, and highlight the importance of nursing consultation for the application of this approach. This study is a literature review. It concludes that interrupting the chain of transmission, as well as developing strategies for prevention, treatment, and counseling is essential in monitoring the patient with genital herpes.

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Genital herpes is an infectious sexually transmitted disease that affects people from different socioeconomic strata, it is widespread throughout the world and a frequent cause of painful genital lesions in men and women. Objective and Methods: to report a case of a patient with penile ulcers initially treated with various topical and oral products, who finally used Uncaria tomentosa gel topically. The final diagnosis was genital herpes. Results:The symptoms of pain and burning had rapid remission. The clinical course was satisfactory and after a week, the patient, with no lesion, reported having had sexual intercourse without discomfort and returned to professional activities. Conclusion: the topical use of Uncaria tomentosa gel 50 mg/g in penile ulcers was well tolerated, and showed no side effects with relief of local symptoms.

Herpes genital é uma doença infectocontagiosa de transmissão sexual que acomete pessoas das mais diversas camadas socioeconômicas e está disseminada em todo o mundo, sendo uma causa frequente de lesões genitais dolorosas em homens e em mulheres. Objetivo e Métodos: descrever caso de paciente com úlceras penianas inicialmente medicado com vários produtos tópicos e orais que por último usou, topicamente, gel de Uncaria tomentosa e o diagnóstico final foi herpes genital. Resultados: os sintomas de dor e ardor tiveram rápida remissão. A evolução clínica foi satisfatória e após uma semana o paciente, já sem lesão, informou ter tido relação sexual sem incômodos e retomado as atividades profissionais de forma plena. Conclusão: o uso tópico de gel de Uncaria tomentosa 50 mg/g em úlceras penianas foi bem tolerado, não teve efeitos colaterais com alívio dos sintomas locais.

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Introducción: En Cuba, se reporta alta incidencia y prevalencia de herpes simple genital. Sin embargo, los/as enfermeros/as encuestadores carecen de una herramienta metodológica para el cuidado de estos pacientes en la Atención Primaria de Salud. Objetivos: Por tal motivo, se realizó un estudio que respondió a un proyecto de desarrollo con el objetivo de diseñar un programa psicoeducativo para disminuir el riesgo en la salud sexual y los problemas psicosociales de los pacientes con diagnóstico clínico de herpes simple genital. Métodos: Para el diseño del programa psicoeducativo se utilizaron las tres primeras etapas del modelo de Giordan. En este sentido, se realizó un estudio fenomenológico en 8 pacientes con diagnóstico de herpes simple genital, para determinar las necesidades de aprendizaje y se sometió a criterio de expertos para establecer los objetivos, métodos y contenidos del programa psicoeducativo. Resultados: El programa quedó conformado por seis sesiones encaminadas a disminuir los problemas psicosociales, incrementar la autoeficacia en el uso del condón, el conocimiento sobre la enfermedad, la eficacia para tener sexo seguro y la eficacia para comunicar la enfermedad. Conclusiones Se diseñó un programa psicoeducativo que incorporó cinco ejes (problemas psicológicos, conocimientos sobre la enfermedad, uso del condón, sexo seguro y revelado de la enfermedad).(AU)

Introduction: In Cuba a high incidence and prevalence of genital herpes simplex is reported. However, nurses and pollters have not available a methodological means for the care of these patients in Primary Health Care. Objectives: Thus, authors conducted an study that is in keeping with to a project of development to design a psycho-educational program to decrease the risk in sexual health and the psychosocial problems of patients clinically diagnosed with genital herpes simplex. Methods: For design of above mentioned program the three stages of the Giordan form were used. In this sense, a phenomenology study was conducted in 8 patients diagnosed with genital herpes simplex, to determine the needs of learning submitting to expert's criteria to establish the objectives, methods and contents of psycho-educational program. Results: The program included six sessions aimed to decrease the psychosocial problems, to increase the self-effectiveness in the use of condom, the knowledge on disease, a safe intercourse and the efficiency to communicate the disease. Conclusions: A psycho-educational program was designed incorporating five key features (psychological problems, knowledges on disease, use of condom, safe intercourse and developing of disease).(AU)

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Introducción: En Cuba, se reporta alta incidencia y prevalencia de herpes simple genital. Sin embargo, los/as enfermeros/as encuestadores carecen de una herramienta metodológica para el cuidado de estos pacientes en la Atención Primaria de Salud. Objetivos: Por tal motivo, se realizó un estudio que respondió a un proyecto de desarrollo con el objetivo de diseñar un programa psicoeducativo para disminuir el riesgo en la salud sexual y los problemas psicosociales de los pacientes con diagnóstico clínico de herpes simple genital. Métodos: Para el diseño del programa psicoeducativo se utilizaron las tres primeras etapas del modelo de Giordan. En este sentido, se realizó un estudio fenomenológico en 8 pacientes con diagnóstico de herpes simple genital, para determinar las necesidades de aprendizaje y se sometió a criterio de expertos para establecer los objetivos, métodos y contenidos del programa psicoeducativo. Resultados: El programa quedó conformado por seis sesiones encaminadas a disminuir los problemas psicosociales, incrementar la autoeficacia en el uso del condón, el conocimiento sobre la enfermedad, la eficacia para tener sexo seguro y la eficacia para comunicar la enfermedad. Conclusiones Se diseñó un programa psicoeducativo que incorporó cinco ejes (problemas psicológicos, conocimientos sobre la enfermedad, uso del condón, sexo seguro y revelado de la enfermedad)(AU)

Introduction: In Cuba a high incidence and prevalence of genital herpes simplex is reported. However, nurses and pollters have not available a methodological means for the care of these patients in Primary Health Care. Objectives: Thus, authors conducted an study that is in keeping with to a project of development to design a psycho-educational program to decrease the risk in sexual health and the psychosocial problems of patients clinically diagnosed with genital herpes simplex. Methods: For design of above mentioned program the three stages of the Giordan form were used. In this sense, a phenomenology study was conducted in 8 patients diagnosed with genital herpes simplex, to determine the needs of learning submitting to expert's criteria to establish the objectives, methods and contents of psycho-educational program. Results: The program included six sessions aimed to decrease the psychosocial problems, to increase the self-effectiveness in the use of condom, the knowledge on disease, a safe intercourse and the efficiency to communicate the disease. Conclusions: A psycho-educational program was designed incorporating five key features (psychological problems, knowledges on disease, use of condom, safe intercourse and developing of disease)(AU)

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O herpes genital é uma doença infectocontagiosa sujeita a recidivas, tendo como agente etiológico duas cepas diferentes do vírus herpes simples (HSV), o tipo 1 (HSV-1) e o tipo 2 (HSV-2). A grande maioria dos casos de herpes genital é causada pelo HSV-2, embora a prevalência do HSV-1 esteja em ascensão, principalmente na população jovem e devido à prática de sexo oral. A manifestação clínica pode ser primária ou recorrente, esta última acontecendo por reativação viral. O diagnóstico é feito pelas características clínicas associadas às confirmações laboratoriais da infecção. Diversos estudos clínicos e epidemiológicos demonstram a sinergia entre herpes genital e aids. Na gravidez, a grande preocupação acerca da infecção pelo HSV refere-se à morbidadee à mortalidade associadas à infecção neonatal. Atualmente não existe nenhum tratamento eficaz na cura do herpes genital, mas alguns medicamentos antivirais são capazes de diminuir o tempo da doença e prevenir as erupções. A maioria dos esforços para combater a infecção herpética genital concentrase no desenvolvimento de vacinas.

Genital herpes is an infectious disease subject to recurrent crises, with the etiologic agent of two different strains of herpes simplex virus (HSV), the type 1 (HSV-1) and type 2 (HSV-2). The vast majority of genital herpes cases is caused by HSV-2, although the prevalence of HSV-1 is on the rise, especially in young population and due to oral sex. The clinical manifestations may be primary or recurrent, the latter going on viral reactivation. The diagnosis is made by the clinical characteristics associated with laboratory confirmation of infection. Several epidemiological and clinical studies demonstrate the synergybetween genital herpes and aids. In pregnancy, the major concern about HSV infection refers to the morbidity and mortality associated with neonatal infection. Currently, there is no treatment capable of curing genital herpes, but some antiviral drugs are able to decrease the duration of the disease and prevent flares. Most efforts to combat genital herpes infection are focused on vaccine development.

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Introdução: herpes genital é uma doença infectocontagiosa de transmissão sexual que acomete pessoas das mais diversas camadas sociais. Herpes genital está disseminado em todo o mundo e é uma causa frequente de lesões genitais dolorosas em homens e em mulheres. Objetivo e Métodos: descrever caso de mulher adulta com quadro clínico e citológico de primomanifestação de herpes genital vulvar, no qual foi usado, na lesão, gel com 50 mg/g de Uncaria tomentosa três vezes ao dia, durante 4 dias. Resultados: os sintomas de dor e ardor tiveram rápida remissão. Ainda na consulta, cerca de 25 minutos apósaplicação tópica do fitoterápico, a paciente relatou grande melhora do quadro doloroso genital. A evolução clínica foi satisfatória e após 6 dias a paciente, já sem lesão, informou ter tido coito vaginal sem incômodos. Conclusão: a aplicação tópica de gel de Uncaria tomentosa em primomanifestação de herpes genital vulvar foi bem tolerada, não apresentou efeitos colaterais e melhorou rápida e sensivelmente o quadro clínico da doença.

Introduction: genital herpes is a sexually transmitted infectious disease that affects people from many different social strata. Genital herpes is spreadb worldwide and is a frequent cause of painful genital sores in men and women. Objective and Methods: to describe the case of adult women with clinical and cytologic clinical picture of a vulvar initial outbreak of genital herpes in which the lesion was treated with Uncaria tomentosa gel 50 mg/g three times a day for four days. Results: the symptoms of pain and burning had rapid remission. During the consultation, about 25 minutes after topical application of theherbal medicine, the patient reported great improvement in genital pain. The clinical outcome was satisfactory and after six days the patient, whose lesion had already healed, reported having had vaginal intercourse without discomfort. Conclusion: application of Uncaria tomentosa topical gel in a vulvar initial outbreak of genital herpes was well tolerated, showed no side effects, and rapidly and significantly improved the clinical symptoms of disease.

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