164 - Herpes Simplex Flashcards by dvojnd rivera

Most prevalent sexually transmitted disease worldwide

Most common cause of ulcerative genital disease

Genital herpes

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The incidence of primary infection with HSV-1 is greatest during

Childhood

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Acquisition of HSV-2 correlates with

Sexual behavior

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Y/N: Most persons infected with HSV-1 or HSV-2 are asymptomatic

Yes

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Y/N: Even though HSV-asymptomatic persons shed virus less frequently than symptomatic persons, the amount of HSV-2 shed during asymptomatic shedding is similar in symptomatic and asymptomatic groups

Yes

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It is estimated that more than _____% of HSV-2 transmission is associated with asymptomatic shedding

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As with other sexually-transmitted infections, the rate of acquisition of HSV-2 infection is higher for (men/women)

Women

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Asymptomatic HSV-2 infection is more common among

Men

Persons who are also seropositive for HSV-1

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(Primary/Recurrent) infections with HSV are usually more severe, frequently involve systemic signs and symptoms, and have a higher rate of complications

Primary

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Most commonly affected area in orofacial herpes reactivation

Outer one-third of the lower lip

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Stages of classical herpes lesions

Prodromal, erythema, and papule (developmental stage)
Vesicle, ulcer, and hard crust (disease stage)
Dry flaking and residual swelling (resolution stage)

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Triggers for oral herpes recurrences

Emotional stress
Illness
Exposure to sun
Trauma
Fatigue
Menses
Chapped lips
Season of the year
Exposure to UV irradiation
Trigeminal nerve surgery
Oral trauma
Epidural administration of morphine
Abrasive laser
Chemical facial cosmetic procedures

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HSV-2 orolabial infections are 120 times (more/less) likely to reactivate than orolabial HSV-1 disease

Less

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Y/N: Acquisition of HSV-1 in a person with prior HSV-2 infection is unusual

Yes

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Y/N: HSV-2 acquisition in the presence of previous HSV-1 infection is common

Yes

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Infections caused by HSV-2 reactivate approximately 16 times (more/less) frequently than HSV-1 genital infections

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Average recurrence of HSV-2 genital infections per year

3 to 4 times

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Infection of the fingers by HSV acquired by direct inoculation or direct spread from mucosal sites at the time of primary infection

Herpetic whitlow

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Y/N: Surgical drainage is often needed for herpetic whitlow

No - unnecessary and potentially harmful

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Cutaneous herpes transmitted in wrestling

Herpes gladiatorum

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Cutaneous herpes transmitted in rugby

Herpes rugbiorum or scrum pox

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Results from widespread infection following inoculation of virus to skin damaged by eczema

Eczema herpeticum (Kaposi varicelliform eruption)

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Antimicrobial peptides that inhibit HSV replication

Cathelicidin

Beta-defensins

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Mortality in eczema herpeticum was primarily caused by

Bacterial superinfection and bacteremia

Recurrent HSV infection is the most common precipitating event in cases of

Recurrent erythema multiforme

Primary maternal genital herpes is associated with a risk of neonatal infection of _____% for vaginally-delivered babies

25-50

Recurrent maternal HSV infection is associated with a risk of neonatal transmission of less than _____%

Neonatal herpes infections manifest in 1 of 3 forms

Skin, eye, and mouth involvement Encephalitis Disseminated disease

All HSV infections involve the _____ system

Nervous

HSV encephalitis usually presents with acute focal neurologic symptoms, fever, and involvement of the _____ lobe

Temporal

Most common diagnostic technique for HSV encephalitis

PCR of the cerebrospinal fluid for HSV DNA

Y/N: Recurrent and persistent ulcerative HSV lesions are among the most common and defining opportunistic infections in patients with AIDS

Yes

Constant immune surveillance and engagement are required to maintain latency, mainly by HSV-specific _____ lymphocytes

CD8+

Patients with defects in (cellular/humoral) immunity have no increase in HSV disease severity

Humoral

Only approximately _____% of fresh genital lesions are culture positive

60-70

Isolation of virus is most successful when lesions are cultured

During the vesicular stage | When specimens are taken from immunocompromised patients or from patients suffering from a primary infection

More sensitive than viral isolation | Preferred method for diagnosis

PCR

Enable typing of the isolate as HVS-1 or HSV-2

Viral culture | PCR assays

Tzanck test is positive in fewer than _____% of culture-proven cases

Cesarean section delivery may not reliably prevent neonatal HSV infection when

Membranes are ruptured for long periods (24 hours or more)

For women at or beyond _____ of gestation who are at risk for recurrent HSV infection, suppressive antiviral therapy has been recommended

36 weeks

Acyclovir must be phosphorylated to be active, and it requires the viral _____ for phosphorylation

Thymidine kinase

Oral prodrug of acyclovir that achieves 3- to 5-fold higher bioavailability

Valacyclovir

Well absorbed oral form of penciclovir

Famciclovir

Topical cream approved by the US FDA for the treatment of herpes simplex labialis

Penciclovir 1% cream

Approved by the FAD for nonprescription treatment of recurrent herpes labialis Long-chain saturated alcohol that inhibits entry of lipid-enveloped virus into the cell

Docosanol 10% cream

Treatment of choice for disseminated or severe herpes infections

Intravenous acyclovir 10 to 15 mg/kg every 8 hours

Dose of intravenous acyclovir for neonatal herpes

20 mg/kg per dose given every 8 hours

Most effective management strategy for persons with frequent or complicated genital recurrences

Long-term suppressive therapy with acyclovir or its analogs

Y/N: Suppressive therapy with valacyclovir was more effective to reduce the burden of genital herpes disease than episodic therapy

Yes

Y/N: Orolabial HSV infections warrant the same antiviral treatment as do genital infections

No - warrant antiviral treatment less often

Y/N: Oral infections are inherently briefer and less symptomatic than genital herpes

Yes

Y/N: Creams and ointments containing 5% and 10% acyclovir are not beneficial in recurrent herpes labialis

Yes

Y/N: The use of suppressive acyclovir for recurrent herpes labialis is recommended

No - controversial

Virtually all clinically relevant drug resistance has been seen in

Immunocompromised patients

Effective in the treatment of acyclovir-resistant HSV Does not require activation by HSV thymidine kinase Requires IV therapy

Foscarnet

Adverse effects of foscarnet

Nephrotoxicity Electrolyte disturbances Anemia Seizures

Intravenous cidofovir is associated with considerable nephrotoxicity and requires the coadministration of

Saline hydration and probenecid

Treatment for acyclovir-resistant HSV

``` Foscarnet Cidofovir Imiquimod Resiquimod Continuous IV acyclovir ```