Herpes Flashcards
What are the red flags for HSV1 ?
age?
lesions presents for longer than how long?
lesion appear how?
____ sx.
caution not ci: ______ immune system.
frequent recurrences defined as ?
<12yrs,
lesions presents for >14 days,
lesion appears infected (excessively swollen, red, or pus),
sx of systemic illness (fever, swollen glands),
compromised immune system d/t meds or disease,
frequent recurrences >6x/yr
Are serology tests used to Dx HSV1 ?
No.
* Diagnosis based on presence of typical signs and symptoms – need to rule out other conditions with similar signs/symptoms (see differential assessments)
* If uncertainty, HSV best confirmed by HSV PCR swab of lesion (or culture) .
* Serology tests NOT typically used for diagnosis
choric suppressive tx for HSV 1 is appropriate for:
- appropriate for waht kind of pts?
- May be used for wjat other reason?
- oral or topical or both?
- appropriate for pts who are psychologically distressed (freq episodes or severe disease)
- May be used to ↓ transmission to uninfected partners
- Oral tx only
When iS INTERMITTENT SUPPRESSIVE THERAPY used?
when recurrences can be ANTICIPATED (i..e if you know everytime you go skiing even if u use spf you get a cold sore, can consider this method.)
what oral analgesics are recommended for mod-sevre pain lasting < 3 days?
acetminophen ibuprofen
what are some optiosn for topical anesthetics?
- useful for mild pain and relatively short time period
- Benzocaine (e.g., Anbesol, Orajel, Zilactin-B)
- Camphor/menthol/phenol (Blistex)
- Lidocaine
- Pramoxine (Gold Bond Medicated anti-itch, Polysporin itch relief)
What is another NON ANTIVIRAL TOPICAL agent you can recommend for codl sores?
- avoid what otc?
Protectants: (e.g. petrolatum, zinc oxide, cocoa butter, allantoin or calamine) –> – prevent cracking and excess drying of lips and lesion
- avoid ASTRINGENTS (TANNIC ACID).
Has zinc, heparin and benzyl alcohol shown any benefit?
no. no evidence it’s safe or efficacious.
what is the medicinal ingredient in coldsore-fx?
- what is its evidence rating for cold sores?
propolis 3%.
- Propolis is a resinous substance bees collect from variety of plant source
- possibly effective –> can try if wnt to.
Has Lysine supplementation shown to PREVENT herpes simplex infections?
- waht is its efficacy rating?
– Doses < __ g/day - FOUND TO BE ineffective for prophylaxis or treatment
– Doses > __ g/day - at higher doses, more of a subjective exp. appear to improve subjective experience of the disease
no.
- “possible effective”
– Doses < 1 g/day - FOUND TO BE ineffective for prophylaxis or treatment
– Doses > 3 g/day - at higher doses, more of a subjective exp. appear to improve subjective experience of the disease
What are the 2 topical antiviral optsion for oral herpes?
- Both should be applied when? will it have effect after sores have broken out?
- these topical agetns dcr helaing and pain time by how miuch?
- how often should they be applied?
Acyclovir 5% topical (Xerese) and Docosanol (Abreva)
BOTH should be applied during PRODROME STAGE (before the cold sore breaks out)!! It wont hurt if applied later, it’ll just have little to no effect. If started properly, reduce pain and healing by only half a day. And they can be expensive.
NOTE: how often they need to be applied (5x day until healed) vs PO therapy.
- half day only.
- 5 times daily until healed and start during prodorome.
whats the active ingredient in abreva?
- how does it work?
- WHY dont antivirals cure hsv?
docosanol
moa: prevents entry into other epithellial cells and blocks spread.
- Antivirals work on ACTIVELY REPLICATING VIRUS, NAD HSV CAN HIDE IN LATENT FORM IN NERVES.
Waht is the trx for PRIMARY INFECTION OF HSV 1?
- PO Antivirals dcr disease duration by how many days?
MUST USE ORAL ANTIVIRAL THERAPY!!!!!
MANY OPTIONS FOR PO (DON’T MEM DOSES):
– Acyclovir 15 mg/kg (up to 200 mg) 5 times a day x 7 days
– Valacyclovir 1 g twice a day x 7 days
– Famciclovir 500 mg twice a day x 7 days
- by 6 days! (duration of lesions 4 days with acyclovir versus 10 days with placebo)
how much do ORAL ANTIVRIALS dcr healing time? pain duration?
- DCR HEALING TIME BY 1-2 days (more effective than topical antiviral therapy (only reduces by half a day).
- dcr pain by 1 day.
is CHRONIC SUPPRESSIVE THERAPY common for hsv1?
no! –> Not common for preventing recurrences in HSV-1!!! Can be considered but veryyy uncommon. Chronic suppresive therapy is often used fro hsv2 tho.
