Herpes Flashcards
What is the definition of ‘initial episode’ of herpes simplex virus?
First episode with either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).
This is then further subdivided dependent on whether the individual has had prior exposure to the other type
What is the definition of ‘Primary infection’ with herpes simplex virus?
first infection with either HSV-1 or HSV-2 in an individual with NO pre-existing antibo- dies to EITHER type
What is the definition of ‘Non-primary infection’ with herpes simplex virus?
first infection with either HSV- 1 or HSV-2 in an individual WITH pre-existing anti- bodies to the OTHER type
What is the definition of ‘Recurrent episode’ of herpes simplex virus?
RECURRENCE OF CLINICAL SYMPTOMS due to reactivation of pre-existent HSV-1 or HSV-2 infection after a period of latency
Which herpes simplex virus is the most common cause of genital herpes in the UK?
HSV-1
Which herpes simplex virus is the most common cause of RECURRENT ano-genital herpes in the UK?
HSV-2
What proportion of people develop symptoms at the time of primary infection with HSV-2?
1/3 (one third)
What is the incubation period for herpes simplex virus?
2 days to 2 weeks
What effect does prior infection with HSV-1 have on the first infection by HSV-2?
modifies the clinical manifestations, usually making symptoms less severe
What factor makes HSV-1 the more likely cause of primary genital herpes than HSV-2?
Younger age (women <50 years, men <35years)
How much more likely is recurrent episodes for HSV-2 than HSV-1?
FOUR TIMES more frequent
Which anatomical sites can herpes simplex virus be shed from ASYMPTOMATICALLY?
external genitalia
anorectum
cervix
urethra
What 2 factors increase the frequency of HSV-2 shedding in HIV positive people?
low CD4 counts
seropositive for HSV-1
When are systemic symptoms most common in any-genital herpes?
PRIMARY infection rather than in non-primary or recurrent disease
What is the distribution/pattern of lesions and lymphadenitis in initial episode of ano-genital herpes?
usually bilateral
When would superinfection of herpetic lesions typically occur?
SECOND week
What increases the risk of auto-inoculation of HSV?
damaged and inflamed skin
this can occur in both acquisition and recurrent disease
What are the potential complications of herpes simplex virus?
Superinfection
Autonomic neuropathy resulting in urinary retention
auto inoculation
aseptic meningitis
How may atypical genital herpes present?
small, non-specific erythema, erosions, or fissures
What percentage of proctitis is due to HSV?
16%
What percentage of MSM with HSV-associated proctitis had visible external anal ulceration?
32%
What method is used to identify HSV from lesions?
HSV DNA detection by polymerase chain reaction (PCR)
What percentage of cultures will miss a diagnosis of herpes?
30%
When can HSV serology be considered?
recurrent genital disease of UNKNOWN CAUSE
to help identify recent or established infection in order to aid counselling - eg pregnancy
investigating asymptomatic partners of patients - eg planning pregnancy, possible discordant relationships
What general guidance should be given for first episode genital herpes?
Saline bathing
analgesia
topical aesthetic agents
When should oral antivirals be considered for herpes?
within 5 days of start of episode
new lesions still forming
systemic symptoms persist
When are intravenous antivirals indicated for genital herpes?
unable to swallow or tolerate medication due to vomiting
What is the treatment for genital herpes?
acyclovir 400mg 3 times daily FIVE days
valaciclovir 500mg twice daily FIVE days
acyclovir 200mg five times daily FIVE days
famciclovir 250mg 3 times daily FIVE days
What complications may occur from ano-genital herpes?
Urinary retention
meningism
Severe constitutional symptoms
What 3 strategies can be offered to patients with recurrent and-genital herpes?
supportive therapy only
episodic antiviral treatments
suppressive antiviral therapy
What benefit is there for episodic antiviral treatment fo recurrent ano-genital herpes?
reduction in duration is a median of 1–2 days
When should patient-initiated therapy be started for another-genital herpes?
First sign of symptoms
treatment prior to the development of papules is of greatest benefit
What is the preferred treatment regimen for episodic treatment of genital herpes?
Short course therapies
Aciclovir 800mg three times daily for 2 days
valaciclovir 500mg twice daily for 3 days
Famciclovir 1gram twice daily for ONE day
When can suppressive therapy for herpes be considered?
6 recurrences per year
significant anxiety due to diagnosis
What are the recommended regimens for suppressive therapy for herpes?
Aciclovir 400 mg twice daily
Aciclovir 200 mg four times daily
Famciclovir 250 mg twice daily
Valaciclovir 500 mg once daily
MALE Condom use reduces rate of transmission of herpes by what percentage?
50%
Antivirals reduce asymptomatic viral shedding, by how much?
80-90% reduction
When may auto inoculation occur with herpes infection?
first infection
compromised skin immunity eg eczema
What complications may occur for a person immunocompromised with herpes infection eg HIV not on treatment?
severe, prolonged with risk of progressive, multifocal, and coalescing mucocutaneous anogenital lesions
potentially life-threatening systemic complications
- fulminant hepatitis
- pneumonia
- neurological disease
- disseminated infection
In patients with advanced HIV and ano-genital herpes infection what change should be made to their antiviral medication? eg aciclovir
DOUBLE dose
5 day course may need EXTENDED
In drug-resistant herpes in PWHIV what may be effective?
topical 1% foscarnet cream
topical 1% cidofovir gel
What is the preferred treatment for drug-resistant herpes in PWHIV?
IV foscarnet or cidofovir
