Herpes

Question 1

most cases orolabial what hsv?

Answer 1

hsv1

Question 2

hsv for genital herpes

Answer 2

Hsv2

Question 3

tx orolabial herpes

Answer 3

IV ACYCLOVIR 5mg/kg 3x/day.

oral: acyclovir susp15mg/kg 5x daily for 7 days,
Valacyclovir 1g 2x a day for 7days.
Famciclovir 500mg 2x a day for 7 days.

this tx reduced duration or illness by more than 50%.

Question 4

most freq clinical manif of orolabial herpes

Answer 4

cold sore
fever blister

lips near vermillion are most freq involved

Question 5

surgical prophylaxis in pxs w history or orolabial herpes

Answer 5

Famciclovir 250mg twice daily,
valacyclovir 500mg twice dail
oral acyclovir 400mg 3x a day

24 hrs prior procedure

Question 6

for routine surgeries at sites of hsv recurrence ( upper and lower lip)

Answer 6

acyclovir 200mg 5x daily
famciclovir 250mg 3x day
valacyclovir 1g 2x a day
starting 2-5 days before procedure for 5 days

Question 7

recurrent id initial herpes infections may promarily affext hair follicle

Answer 7

Herpetic sycosis

confirmed by biopsy

Question 8

under age 25 which is more common hsv 1 or 2?

Answer 8

Hsv1 - more than 50% of cases of genital herpes. whereas women over 25 and men of all ages- hsv2.

Question 9

of all ages, over 25, men. 1/2?

Answer 9

HSV2

Question 10

genital herpes inc period

Answer 10

5 days.

Question 11

risk of transmisison in monogamous couples

Answer 11

5-10% annually

Question 12

how many percent of hsv2 are symptomatic?

Answer 12

57%

Question 13

initial clincial episode of genital herpes tx

Answer 13

Oral acyclovir 200mg 5x or 400 mg 3x daily.
famciclovir 250 mg 3x daily.
valacyclovir 1000mg twice daily for 7 - 10 days

Question 14

sx genital herpes recurrent

Answer 14

prodome burning
Itching and tingling. Usually 24 hours red papules appear at site progress to blisters w clear fluid over 24 hrs, form erosions in net 24-36 hours heal in 2 -3 days.
total duration if a typical outbreak of genital herpes is 7 days.

lesions are usually grouped blisters.

occur in same anatomic rgion
upper buttock common site for recurrent genital herpes in both men and women.

heals wo scarring.

dx of recureentgenital herpes should not be done clinically.
dx best confirmed by- Viral culture pcr dfa Llowing for typing the causative virus.

Question 15

tx for recurent genital herpes

Answer 15

Acyclovir 200mg 5x daily or 800 mg twice a day

famcyclovir 125mg twuce a day for 5days

Question 16

in pxs w frequent recurrences (>6-12 yry) suppressive tx is reasonable.

Answer 16

acuclov 400 mg 2x a day. 200 mg 3x a day. or 800 mg once a day. will suppress 85% kf recurrences and 20% aill be recurrence free during suppressive tx.
vacyclovir 500/day ( 1000mg/day fkr those >10 recurrences/ year )
Famciclovir 250mg twice dailyp

Question 17

85% of neonatal herpes occur when

Answer 17

delivery
5% in utero
10-15% non maternal sources after delivery

Question 18

70% kf neonatal herpes are caused by

Answer 18

Hsv2

in 68% infected babies, skin vesicles are leesentin sign. and a good sourxe for virus recovery

Question 19

dx of neo herp confirmed by

Answer 19

viral culture

70% of mothers of infants w neonatal herpes are asymptomatic

Question 20

risk of infection for an infant del vaginally shen mother has actice recurrent genital herpes

Answer 20

2-5%

26-56% if maternal infection at delivery is a 1st episode

scalp electrode/ avaoided. risk of neonatal indefrion by upto 7 fold.

vaccum - 27x risk for neonatal transmission

Question 21

vaccum assit dev inc relative ris of neonatal transmission of hsv2 by how many times

Answer 21

27 times

Question 22

which is more freq transmitted intrapartum hsv1 /2?

Answer 22

Hsv1

cs is still the recommendarion1 red risk of tramsmision fron 8 to 1 %

Question 23

chronic supp tx w acyclvir has ve used from wht week?

Answer 23

36weeka of gest

Question 24

antiviral tx of all initial wpisodes of genital herpes in pregnancy.

Answer 24

std acyclovir for initial epc 400 mg 3x a day for 10 days

Question 25

infection kr gerpes w AD. speead of herpes rhroughout eczematous areas

Answer 25

Eczema herpeticum (kaposu varicelliform eruption) bath or hot tub exposure- risk factor.

Question 26

topical drug assoc w EH

Answer 26

Topical calcineurin

Question 27

infammatorh mediators assoc w EH

Answer 27

IL10, IL19 | HLA B7/IL25

Question 28

3 clinical hallmarks of hsv

Answer 28

pain active besicular vorder scalloped periphery

Question 29

immunocomp hosy most herpetci lesions present as

Answer 29

ulcerstive not vesicular if ulceration does not respond to tx in 48 hours and cultures are negative; a biopsy is recommended

Question 30

std tx of acyclovie resistant herpes simplex

Answer 30

IV FOSCARNET. if intolerant to foscarnet--- cidovofir IV. resistance to one drug is assoc w resistance to all three of the drugs usually from loss of viral thymidine kinase.

Question 31

H of herpes

Answer 31

Vesicles epidermal leukocytosis in dermis balloning degeneration of epidermal cells prod acantholysis most char feature muktinycleated gian cells. steel gray color id nucleaus and peripheral condensation of nucleoplasm

Question 32

size

Answer 32

medium sized. ds dna. latent but lifelong infection.

Question 33

hav 1 std pxs- rate of infection

Answer 33

30-50%

Question 34

hsv 1 and 2 incidence

Answer 34

hsv1 - 50%- orolabial lesions hsv2- 20%- asymptomatic( latent infection) 20% recurrent genital herpes 60% clinical lesions they do not recognize as sx of hsv

Question 35

orL recurrent herpes affects

Answer 35

kerstinized surfaces of hard palate | attached gingiva.

Question 36

frequent trigger for recurrent orolabial hsv

Answer 36

UV spec UVB

Question 37

in pxs w 6 or more outbreaks per year,

Answer 37

suppressive daily antiviral tx can be used. squaric acid dibutyl ester - immunosenstizer to reduce recurrent outbreaks.

Question 38

herpetic whitlow

Answer 38

infectio occur on fingers or periubgually. begin w tenderness and erythema usually on the lateral nailfold or on the palm. deep seated blisters dev 24-48 hrs after sx begin. bimodal dist. 20% occur in younger than 10 yrs and 55% bet 20-40. all cases in child- hsv1. twice common in women.

Question 39

tx for immunocompromised:

Answer 39

Acyclovir 400mg orally 3x a day famciclovir 500 mg 2x a day valacyclovir 1g 2x aday all for a min of 5-10 days.

Question 40

immunocompromised px, w moderate dx tx.

Answer 40

IV acyclovir 5mg/kg initialy to control dx. in aids, and those w persistent immunosupp consideration- acyclovir 400-800 mg 2 or 3x daily valacyclovir or famcyclovir 500mg 2x a day.