Herpes

Question 1

Choose all correct answers regarding herpes:

a) more than 50% of genital HSV-2 is transmitted during asymptomatic shedding
b) laboratory-based diagnosis of genital herpes is not required if a clinical diagnosis can be made
c) Suppressive treatment is suggested for patients with at least 6 recurrences per year
d) targeted HSV screening is indicated for patients at higher risk of acquiring the virus

Answer 1

a) true 70%
b) false
c) true -also if significant complications, QOL significantly affected, social/sexual dysfunction, to lower risk of transmission to partner/fetus/neonate
d) false

Question 2

Choose all correct answers regarding herpes:

a) herpes virus resides in the dorsal root or sensory ganglion during latent stage of infection
b) HSV 1 more commonly causes genital infection compared to HSV 2
c) viral shedding occurs during the vesicle/pustule phase and the ulceration phase
d) HSV is the most frequent cause of genital ulcerations

Answer 2

a) true
b) false
c) true
d) true

Question 3

List risk factors for acquisition of HSV-2 virus:

Answer 3

more sexual partners, non-caucasian, low SES, hx STIs (including HIV), female, hx genital lesion in self/partner, increasing age

Question 4

List potential modes of transmission for HSV-2 virus;

Answer 4

1. ano-genital (most common 70%)
2. oro-genital
3. mother to baby (transplacental is rare, during labour, after birth from indirect contact with mother’s secretions)

Question 5

Choose correct responses regarding HSV:

a) During primary genital infection, HSV serology will be positive
b) During a recurrence, HSV serology will be positive
c) During asymptomatic shedding, HSV serology will be positive
d) HSV serology testing is not clinically useful

Answer 5

a) false
b) true
c) true
d) false

Question 6

In the absence of symptoms, HSV-2 will be detected in the genital tract on culture on what percentage of days in the 1st year after initial infection and for the next 2 years?

Answer 6

3% in the first year, 1% in the second year (patients are actively shedding if HSV can be detected)

Question 7

What is the treatment of an initial episode of suspected or diagnosed HSV and what is the rationale for treatment?

Answer 7

Acyclovir 400mg PO TID x 10 days (treatment decreases the duration and severity of the outbreak)

Question 8

What is the transmission rate of HSV for a patient on suppressive treatment taking 95% of their pills?

Answer 8

1%

Question 9

List one medication and dosing that can be used for suppressive treatment of HSV-2.

Answer 9

acyclovir 400mg PO BID or 200 TID
famcyclovir 250mg BID
valcyclovir 500mg daily