American family physician
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Genital herpes is a sexually transmitted infection caused by herpes simplex virus (HSV) type 1 or 2. It affects at least 500 million people worldwide and is a lifelong condition involving initial infection and periodic reactivation with variable viral shedding. There are no vaccinations for the prevention of HSV, and routine serologic screening is not recommended in asymptomatic individuals. ⋯ Complications of genital herpes include encephalitis, meningitis, and urinary retention. During pregnancy, antiviral suppression is recommended starting at 36 weeks of gestation in patients with a known history of genital herpes. Elective cesarean delivery should be offered to patients with active lesions to reduce neonatal exposure to HSV.
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Tongue conditions occur in 15.5% of the US population. The most common tongue conditions are geographic tongue, fissured tongue, and black hairy tongue; these conditions do not require treatment. Median rhomboid glossitis can be associated with a candidal infection; symptomatic lesions usually improve with use of antifungals. ⋯ Burning mouth syndrome often involves the tongue, and if it does not resolve spontaneously, studies have shown improvement with gabapentin, topical clonazepam, capsaicin, and cognitive behavior therapy. Oral lichen planus is a chronic inflammatory disorder that can affect the tongue and is best treated with topical or systemic corticosteroids and calcineurin inhibitors. There is a lack of consensus on the definition and treatment of ankyloglossia (tongue-tie); however, some evidence supports that frenotomy can improve breastfeeding and decrease lactation-associated nipple pain.