Herpes

Question 1

HSV-1

Answer 1

HSV-1: predominant cause of oral infections
–MC cause of genital lesions in mex and white women
–Commonly caught in childhood, but less frequent now with better hygiene
–50% of women are sero-positive for HSV-1

Question 2

HSV-2

Answer 2

causes primary genital lesions and most cause of genital lesions in black ppl

Question 3

Recurrence of genital HSV

Answer 3

In pt without ab, attack rate in exposed person is 70%
Incubation period is 1wk
90% of pt with sx will have another episode within a year

Question 4

Three stages of HSV lesions.
When does virus shed?

Answer 4

1. vesicle w/wout pustule formation – lasts about 1wk
2. ulceration
3. crusting

Virus shedding happens during the first 2 phases

Question 5

Additional sx with HSV lesions…

Answer 5

HA, low fever, myalgias
Viral load contributes to sx and # of lesions. Early Rx with antiviral can diminish viral load

Question 6

Length of lesion persistence in primary vs secondary infection

Answer 6

Primary: pain persists for 7-10 days. Lesions heal by 2-3 weeks
Secondary: 2 weeks

Question 7

Prodromal sx for 2nd HSV

Answer 7

2/3 of pt have prodromes. Sx include pruritus and tingling

Question 8

Old gold standard for HSV dx…
What test is most sensitive?

Answer 8

Cell cx
High specificity (high likelihood of neg test if no disease), low sensitivity –> high false negatives

NAAT testing is most sensitive and can detect on tissue w/out lesions

Question 9

Does a negative cx or PCR test mean no HSV?

Answer 9

NO. False neg rate is high whereas false positive rate is low

Question 10

What about ab testing for HSV?

Answer 10

Only IgG ab assays should be ordered. However still highly specific and not as sensitive –> more false neg

NO IgM as they are not type specific and may be + during a recurrent outbreak

Question 11

Do you need dx testing in clinically obvious HSV?

Answer 11

NO. Immediate Rx and addtl STD screening is recommended

Question 12

Do we do serologic screening in the asymp population?

Answer 12

NOT RECOMMENDED

But you can consider it in HIV+ or if pt presents for STD eval if high risk (multip partners)

Question 14

the test of choice for diagnosing HSV infections affecting the central nervous system

Answer 14

PCR is also the test of choice for diagnosing HSV infections affecting the central nervous system (CNS) and systemic infections (e.g., meningitis, encephalitis, and neonatal herpes)

Question 15

What proteins are serologic assays testing for?

Answer 15

accurate type-specific HSV serologic assays are based on the HSV-specific glycoprotein G2 (gG2) (HSV-2) and glycoprotein G1 (gG1) (HSV-1)

Question 16

If primary HSV-2 suspected and testing is negative, what should you do?

Answer 16

in cases of recent suspected HSV-2 acquisition, repeat type-specific antibody testing 12 weeks after the presumed time of acquisition is indicated

Because of the poor specificity of commercially available type-specific tests a confirmatory test (Biokit or Western blot) with a second method should be performed before test interpretation

Question 17

dosing of HSV meds for primary outbreak

Answer 17

Question 18

when should you not treat primary HSV?

Answer 18

NEVER. even those with mild sx can have prolonged recurrent episodes and Neuro involvement

Question 19

can suppression be given to non-preg pts? how long can they continue it?

Answer 19

anyone can have suppression. ask them yrly if they want to continue bc recurrence is less likely as times goes on

BUT they can cont it as long as they want. resistance is unlikely

Rx with valtrex 500mg daily dec transmission in hetero couples

Question 20

Regimens for hsv suppression

Answer 20

Question 21

Episodic Rx for recurrent HSV2

Answer 21

Try to start within 1 day of lesion or if prodromal sx –> will be more effective. Give pt some to keep at home for this reason

Question 22

signs of HSV-2 meningitis. CSF findings

Answer 22

headache, photophobia, fever, meningismus

CSF: lymphocytic pleocytosis, mildly elevated protein and normal glucose

Question 23

signs of severe HSV disease that needs IV Rx
Dosing for IV med

Answer 23

Disseminated infection, pneumonitis, hepatitis, CNS complications (meningitis, encephalitis)

Dosing: IV acyclovir therapy (5–10 mg/kg body weight IV every 8 hours) followed by high-dose oral antiviral therapy (valtrex 1 g 3 times/day) to complete a 10- to 14-day course of total therapy

Question 24

Pregnant women in any trimester can present with fever and ___ but might not have any genital or skin lesions.

Answer 24

Hepatitis with elev LFT

HSV hepatitis is associated with fulminant liver failure and high mortality (25%). Therefore, a high index of suspicion for HSV is necessary, with a confirmatory diagnosis by HSV PCR from blood. Start empiric IV acyclovir pending confirmation

Question 25

HSV suppression for persons with HIV

Answer 25

Question 26

HSV regimens for episodic infection in those with HIV

Answer 26

Question 27

Risk of transmission for HSV during pregnancy

Answer 27

30%–50% among women who acquire genital herpes near the time of delivery and low (<1%) among women with recurrent herpes or who acquire HSV during the first half of pregnancy

Question 28

Is acyclovir safe in pregnancy and BF?

Answer 28

YES

A case-control study reported an increased risk for the rare neonatal outcome of gastroschisis among women who used antiviral medications between the month before conception and the third month of pregnancy

Question 29

Regimens for suppression in preggos

Answer 29