Exam 2 - Genital HSV

Question 1

Genital HSV: signs and symptoms

Answer 1

Gingivostomatitis

• Cluster of oral labial lesions caused by herpes virus

Question 2

How is HSV transmitted?

Answer 2

Through mucous membranes, oral/genital contact with infected source

Question 3

HSV-1 vs HSV-2

Answer 3

Associated with fever blisters or cold sores

Question 4

HSV-1 vs HSV-2

Answer 4

Associated with sexual transmission (increases risk for acquiring HIV)

• More virulent recurrences and higher rate of transmission

Question 5

HSV: initial primary outbreak

Answer 5

• Mild systemic and localized symptoms
  
  • Flu-like symptoms with fever, malaise, myalgia that occurs 1 week after exposure
  • Localized edema, vaginal discharge, dysuria
• Prodromal symptoms prior to onset of lesions
• Symptoms will subside before development of genital lesions/vesicles
  
  • Blisters occur in small groups

Question 6

HSV: secondary outbreaks

Answer 6

• Symptoms less severe than initial infection d/t heightened immune response
• Systemic symptoms absent, but prodromal genital tingling common
• Recurrent lesions less extensive and last 7-10 days without viral shedding
• Lesions begin as vesicles and quickly progress to ulcers

Question 7

HSV: diagnostic testing

Answer 7

• Based on history and physical exam findings
  
  • Confirmed with lab (e.g. PCR culture of fresh lesions that aren’t crusted)
  • IgG based assay available as blood test, but need to request specific glycoprotein G to reveal subtype (useful with recurrent genital symptoms with negative PCR)

Question 8

HSV: treatment (general)

Answer 8

• Test results NOT required to begin treatment
• All patients with first episode of genital herpes should receive antiviral therapy
• Topical therapy is ineffective and NOT recommended

Question 9

HSV: primary outbreak treatment

Answer 9

• Acyclovir
• Valacyclovir
• Famciclovir

Question 10

HSV: recurrent outbreak treatment

Answer 10

Same as for primary outbreak (e.g. acyclovir, valacyclovir, famciclovir), but with modified regimens

Question 11

Is partner therapy necessary with HSV outbreaks?

Answer 11

No, but women should have conversation with her partner

Question 12

HSV: supportive therapy

Answer 12

• Non-narcotic oral analgesics
• Abstain from sexual contact with uninfected partners
• Condom use and suppressive therapy to reduce risk of transmission during asymptomatic intervals
• Reduce consumption of chicken, chocolate, corn, coffee, greens, dairy, meat, nuts, peanut butter, citrus foods

Question 13

How should the patient care for lesions?

Answer 13

• Keep lesions warm and dry –> use hair dryer, patting area gently, wear cotton underwear and loose fitting clothing
• Apply witch hazel compresses
• Oatmeal baths or sitz baths
• Use peri-bottle rinse while urinating to relieve dysuria

Question 14

HSV and pregnancy

Answer 14

• Prenatal screening and pregnancy risk assessment important
• Assesed in labor and deliver
• Those without genital lesions or prodromal symptoms can deliver vaginally
• Women with recurrent genital lesions at onset of labor require c section

Question 15

Acquiring HSV during the ___ half of pregnancy or recurrent infections during pregnancy pose ___ to the fetus

Answer 15

Acquiring HSV during the first half of pregnancy or recurrent infections during pregnancy pose little or no risk to the fetus

Question 16

If transmission or primary outbreak occurs late in pregnancy, risk for transmission to the neonate is as high as ___%

Answer 16

30-50%

• Should be managed by maternal fetal medicine or infectious disease specialists

Question 17

Pharmacological treatment for pregnant women with HSV

Answer 17

Antiviral medications in late pregnancy can reduce frequency of c sections in women with recurrent genital herpes outbreaks (e.g. acyclovir)