Genital Ulcer Disease

Question 1

What % of people get herpes symptoms at the time of catching the virus?

Answer 1

1/3

Question 2

HSV incubation period

Answer 2

2 days- 2 weeks

Question 3

Asymptomatic shedding accounts for what % of hsv transmission?

Answer 3

70%

Question 4

How does prior HSV1 infection alter course of hsv 2 infection?

Answer 4

Less likely to have systemic symptoms likely to have shorter duration of signs and symptoms

Doesn’t effect recurrence rate

Question 5

Whats the recurrence rate in 1st year of infection for HsV 1 and 2?

Answer 5

1: once a year
2: 4x a year

Question 6

What factors can reactive the hsv?

Answer 6

Sun light
Immunocompromise
Fever

Others: uv light, menus, sex, exposure to heat or cold

Question 7

What are other members of the human herpes vitus family other than HSV 1 and 2

Answer 7

HSV 6, 7, 8
Varicella zoster
CMV
EBV

Question 8

What are complications of herpes disease?

Answer 8

Super infection
Urinary retention (due to pain or autonomic neuropathy)
Autoinnoculation
Aseptic meningitis

Question 9

By how much does condom use reduce the transmission of HSV?

Answer 9

30-50%

Question 10

By how much do antivirals reduce shedding?

Answer 10

90%

Question 11

HSV associated with IRIS in PLWHIV may be unresponsive to treatment. What can you use in this case?

Answer 11

Foscarnet and cidofovir

Topical cidofovir 1% gel

Question 12

How does treatment differ in PLWHIV?

Answer 12

Consider double the standard dose

Question 13

Resistant strains of HSV have been seen in what % of PLWHIV?

Answer 13

5-7%

Question 14

Resistance is most commonly related to what?

Answer 14

A mutation in the gene coding for HSV thymidine kinase

Question 15

Is there an increased risk of miscarriage if hsv is acquired in the 1st trimester?

Answer 15

NO

Question 16

What % of neonatal infections are limited to the skin? And when do they usually present?

Answer 16

30%

10-12 days post delivery

Question 17

What are symptoms of disseminated disease kn neonates?

Answer 17

Jaundice 
Gi bleeding
Resp distress
Seizures 
CNS involvement

Question 18

Whats the mortality rate and permanent neurological damage rate of disseminated infection in the newborn?

Answer 18

30% mortality

17% permanent neurology

Question 19

Whats the mortality and neurological morbidity for hsv encephalitis in the newborn?

Answer 19

6% mortality

70% neurological morbidity

Question 20

Lesions at onset of labour. Whats the risk of transmission
A primary episode
B recurrent lesions

Answer 20

A 41%

B 0.3%

Question 21

Whats the neonatal management of
A) lscs to woman with primary hsv in 3rd trimester
B) SVD to woman with primary hsv in 3rd trimester
C) SVD to woman with recurrent hsv lesions at delivery

Answer 21

A liase with neonates and monitor for 24 hours

B swab skin, conjunctiva, oropharynx and rectum
Treat with iv aciclovir 8 hourly
Lp of unwell

C liase with neonates and monitor for 24 hours

Question 22

Whats the treatment for donovanosis?

Answer 22

Azithromycin 1g weekly for 3 weeks or until lesions completely healed

Question 23

PN for donovanosis?

Answer 23

6 months

Question 24

Risks of donovanosis?

Answer 24

Increased risk of carcinoma of the penis

Dissemination is rare with spread to liver and bone (associated with pregnancy and cervical lesions)

Question 25

Chancroid complications

Answer 25

Does NOT disseminate
Philosophy
Partial loss of tissue can rarely cause autpampitation of the penis

Question 26

Chancroid treatment

Answer 26

Azithromycin 1g stat
Or
Ceftriaxone 250mg stat IM

Question 27

PN for chancroid

Answer 27

10 days

Question 28

Chancroid follow up

Answer 28

Re examine in 3-7 days

Ulcers should improve within 3 days and re epitheliaise within 7 days

Question 29

Donovanosis treatment in pregnancy?

Answer 29

Erythromycin 500mg qds weekly for 3 weeks

Question 30

Chancroid treatment for PLWHIV

Answer 30

Ciprofloxacin 500mg bd 3 days

Erythromycjn 500mg qds for 7 days