25 - 164 - HERPES SIMPLEX Flashcards
Differentiate primary and secondary HSV based on severity, systemic signs and symptoms and rate of complications
Primary infections with HSV are usually more severe, frequently involve** systemic signs **and symptoms and have higher rate of complications compared to those associated with reactivation of HSV
What do you call orofacial HSV infections
Herpetic gingivostomatitis and pharyngitis
Common symptoms of orofacial HSV
fever, malaise, myalgia , dysphagia, irritability and cervical adenopathy
What is the most commonly affected area in reactivation of HSV in the perioral area?
Outer 1/3 of the lower lip
Other facial locations include the nose, chin, and cheek, and account for fewer than 10% of cases
Two-thirds of labial lesions involve the vermilion border, and the rest occur at the junction of the border with the skin.
What are the possible prodromal symptoms of herpes labialis?
Pain, burning, itching at the site of the subsequent eruption
What are the stages of herpes infection
- Developmental stage - prodromal, erythema and papule
- Disease stage - vesicle, ulcer and hard crust
- Resolution stage - dry flaking and and residual swelling
The lesions of herpes infection usually resolve in how many days
Within 5 to 15 days
Triggers for oral herpes recurrences
- emotional stress
- illness
- exposure to sum
- trauma
- fatigue
- menses
- chapped lips
- season of the year
Other well-documented triggers include exposure to ultraviolet irradiation, trigeminal nerve surgery, oral trauma, epidural administration of morphine, and abrasive, laser, and chemical facial cosmetic procedures
Which type of HSV causing orofacial infection is LESS LIKELY to reactivate?
HSV-2 orolabial infections are 120 times less likely to reactivate than orolabial HSV-1 disease.
True or false: Acquisition of HSV-1 in a person with prior HSV-2 infection is unusual, but HSV-2 acquisition in the presence of previous HSV-1 infection is common.
TRUE
Most common location of genital herpes in males?
Glans penis or penile shaft
Accompanying symptoms of genital herpes
Pain, itching, dysuria, vaginal and urethral discharge and tender inguinal lymphadenopathies
Systemic signs and symptoms are common and include fever, headache, malaise, and myalgias.
Without treatment genital herpes infections usually heal in how many days?
6 - 10 days
infection of the fingers by HSV acquired by direct inoculation or by direct spread from mucosal sites at the time of primary infection
Herpetic whitlow
Whitlow occurs in children who suck their fingers during a primary gingivostomatitis outbreak. It is also a well documented occupational hazard for medical personnel. It is usually caused by HSV-1, but HSV-2 whitlow may develop as a manifestation of primary inoculation following manual–genital contact with an infected partner.
most common precipitating event in cases of recurrent erythema multiforme
Recurrent HSV infection
HSV-associated erythema multiforme is usually an acute, self-limited, recurrent disease, that lasts approximately 3 weeks.
The lesions are usually symmetric, occurring on acral extremities and the face, and there is grouping of lesions over the elbow and knees as well as nailfold involvement. Mucosal involvement is usually mild and restricted to the mouth. Constitutional symptoms are rare, and the skin lesions heal without scarring.
T/F: All HSV infections involve the nervous system, as neurons are the sole proven site of virus latency.
True
For patients with active lesions, HSV can be isolated in
Cell culture
In culture, HSV causes typical cytopathic effects, and most specimens will prove positive within 48 to 96 hours after inoculation. The sensitivity of culture depends on the quantity of virus in the specimen.
Isolation of virus is most successful when lesions are cultured during the ________ stage
Vesicular stage
and when specimens are taken from immunocompromised patients or from patients suffering from a primary infection.
more sensitive than viral isolation and has become the preferred method for diagnosis of HSV
PCR
Both viral culture and PCR assays enable typing of the isolate as HSV-1 or HSV-2.
This information helps to predict the frequency of reactivation after a first episode of HSV infection.
How can you differentiate a primary from a recurrent HSV infection
Serologic detection of IgG antibodies to HSV
- The main function of serologic testing is to differentiate a primary episode from a recurrent infection.
How you do Tzanck Smear/test
It is performed by scraping the base of a freshly-ruptured vesicle and staining the slides with Giemsa or Wright stain (the Papanicolaou staining method also can be used), followed by examination for multinucleated giant cells that are diagnostic of herpetic infection
Differential diagnoses for orolabial herpes
Differential diagnoses for Genital Herpes
Clinical course and prognosis of HSV
Although most patients with HSV infections are asymptomatic, primary infections can be severe. Most recurrences are asymptomatic, but symptomatic recurrences are milder than symptomatic primary infections. The frequency and severity of recurrent HSV-1 and HSV-2 disease decrease over time; therefore, the need for continued suppressive therapy should be reevaluated.
How should you counsel patients with genital herpes
Patients with genital herpes should be counseled to refrain from sexual intercourse during outbreaks and for 1 to 2 days after, and to use condoms between outbreaks. Suppressive antiviral therapy is also an option for individuals concerned about transmission to a partner.
T/F. All HSV infections require antiviral medications due to risk of complications when untreated
FALSE
Many HSV infections require no specific treatment. Keeping lesions clean and dry while they heal by themselves may be all that is required.
Treatment is warranted for infections that are likely to prove protracted, highly symptomatic, or complicated.
Any strain of HSV that requires more than ____ µg/mL of acyclovir to be inhibited is said to be relatively drug resistant.
> 3
approved by the U.S. Food and Drug Administration (FDA) for the treatment of herpes simplex labialis
Penciclovir 1% cream
approved by the FDA for nonprescription treatment of recurrent herpes labialis
Docosanol 10% cream
Treatment for primary orofacial HSV
Prophylaxis for recurrent orofacial HSV
Acyclovir, 400 mg orally twice a day
Start just before and during precipitating event, such as intensive ultraviolet light exposure
For disseminated or severe herpes infections, what is the treatment of choice
intravenous acyclovir 10 to 15 mg/kg every 8 hours
The dose of intravenous acyclovir for neonatal herpes
20 mg/kg per dose given every 8 hours
Recommended regimen of genital HSV infection
Pediatric dose of primary orofacial HSV infection
Acyclovir 15 mg/kg orally 5x/day x 7-10 days or until resolution of symptoms
Pediatric Acyclovir dose of primary Genital HSV
Acyclovir, 40-80 mg/kg/day orally divided in 3 0 4 doses (maximum of 1g/day) x 7 -10 days or until clinical resolution of symptoms
Treatment of HSV infection is only effective during?
Treatment is only effective if used very early in the disease, especially in the prodromal or erythema lesion stages.
approved by the FDA for nonprescription treatment of herpes simplex labialis
Docosanol 10% cream
It is applied 5 times a day at the first sign of recurrence of herpes simplex labialis.
Reactivation of virus from primary infections involves the perioral facial area, the most commonly affected area is
A. Middle one-third of upper lip
B. Middle one-third of lower lip
C. Outer one-third of upper lip
D. Outer one-third of lower lip
D
In males, Genital herpes commonly occur on the
A. Glans penis
B. Scrotum
C. Anus
D. Corona
A
This drug is associated with considerable nephrotoxicity and requires the coadministration of saline hydration and probenecid
A. IV acyclovir
B. IV foscarnet
C. IV valacyclov
D. IV Cidofovir
D
Which is true:
A. risk of transmit- ting herpes to the baby during childbirth is extremely low
B. primary HSV infection during pregnancy should not be treated
C. For disseminated or severe herpes infections, the treatment of choice remains intravenous acyclovir 10 to 15 mg/kg every 6 hours.
D. Antiviral treatment of initial herpes episodes decreases subsequent recurrences
A
Patients with genital herpes should be counseled to refrain from sexual intercourse during outbreaks and for__days after
A. 1 to 2
B. 2 to 3
C. 4 to 5
D. 5 to 7
A
isolation of virus is most successful when lesions are cultured during the
A. Development stage
B. Vesicular stage
C. Crust stage
D. Any stage
B
Without treatment, the genital lesions usually heal in how many days
6 - 10 days
HSV 2, in females, lesions may involve the following except:
A. Buttocks
B. Vulva
C. Cervix
D. Urethra
D
May involve vulva, perineum, buttocks, vagina, or cervix
the most prevalent sexually transmitted disease worldwide and is the most common cause of ulcerative genital disease;
Genital herpes
the major clinical presentation of HSV-2 infection
genital herpes
