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DipGUM > Herpes > Flashcards

Herpes Flashcards

1
Q

What is the definition of ‘initial episode’ of herpes simplex virus?

A

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

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2
Q

What is the definition of ‘Primary infection’ with herpes simplex virus?

A

first infection with either HSV-1 or HSV-2 in an individual with NO pre-existing antibo- dies to EITHER type

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3
Q

What is the definition of ‘Non-primary infection’ with herpes simplex virus?

A

first infection with either HSV- 1 or HSV-2 in an individual WITH pre-existing anti- bodies to the OTHER type

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4
Q

What is the definition of ‘Recurrent episode’ of herpes simplex virus?

A

RECURRENCE OF CLINICAL SYMPTOMS due to reactivation of pre-existent HSV-1 or HSV-2 infection after a period of latency

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5
Q

Which herpes simplex virus is the most common cause of genital herpes in the UK?

A

HSV-1

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6
Q

Which herpes simplex virus is the most common cause of RECURRENT ano-genital herpes in the UK?

A

HSV-2

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7
Q

What proportion of people develop symptoms at the time of primary infection with HSV-2?

A

1/3 (one third)

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8
Q

What is the incubation period for herpes simplex virus?

A

2 days to 2 weeks

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9
Q

What effect does prior infection with HSV-1 have on the first infection by HSV-2?

A

modifies the clinical manifestations, usually making symptoms less severe

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10
Q

What factor makes HSV-1 the more likely cause of primary genital herpes than HSV-2?

A

Younger age (women <50 years, men <35years)

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11
Q

How much more likely is recurrent episodes for HSV-2 than HSV-1?

A

FOUR TIMES more frequent

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12
Q

Which anatomical sites can herpes simplex virus be shed from ASYMPTOMATICALLY?

A

external genitalia
anorectum
cervix
urethra

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13
Q

What 2 factors increase the frequency of HSV-2 shedding in HIV positive people?

A

low CD4 counts

seropositive for HSV-1

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14
Q

When are systemic symptoms most common in any-genital herpes?

A

PRIMARY infection rather than in non-primary or recurrent disease

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15
Q

What is the distribution/pattern of lesions and lymphadenitis in initial episode of ano-genital herpes?

A

usually bilateral

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16
Q

When would superinfection of herpetic lesions typically occur?

A

SECOND week

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17
Q

What increases the risk of auto-inoculation of HSV?

A

damaged and inflamed skin

this can occur in both acquisition and recurrent disease

18
Q

What are the potential complications of herpes simplex virus?

A

Superinfection
Autonomic neuropathy resulting in urinary retention
auto inoculation
aseptic meningitis

19
Q

How may atypical genital herpes present?

A

small, non-specific erythema, erosions, or fissures

20
Q

What percentage of proctitis is due to HSV?

A

16%

21
Q

What percentage of MSM with HSV-associated proctitis had visible external anal ulceration?

A

32%

22
Q

What method is used to identify HSV from lesions?

A

HSV DNA detection by polymerase chain reaction (PCR)

23
Q

What percentage of cultures will miss a diagnosis of herpes?

A

30%

24
Q

When can HSV serology be considered?

A

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

25
Q

What general guidance should be given for first episode genital herpes?

A

Saline bathing
analgesia
topical aesthetic agents

26
Q

When should oral antivirals be considered for herpes?

A

within 5 days of start of episode
new lesions still forming
systemic symptoms persist

27
Q

When are intravenous antivirals indicated for genital herpes?

A

unable to swallow or tolerate medication due to vomiting

28
Q

What is the treatment for genital herpes?

A

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

29
Q

What complications may occur from ano-genital herpes?

A

Urinary retention
meningism
Severe constitutional symptoms

30
Q

What 3 strategies can be offered to patients with recurrent and-genital herpes?

A

supportive therapy only
episodic antiviral treatments
suppressive antiviral therapy

31
Q

What benefit is there for episodic antiviral treatment fo recurrent ano-genital herpes?

A

reduction in duration is a median of 1–2 days

32
Q

When should patient-initiated therapy be started for another-genital herpes?

A

First sign of symptoms

treatment prior to the development of papules is of greatest benefit

33
Q

What is the preferred treatment regimen for episodic treatment of genital herpes?

A

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

34
Q

When can suppressive therapy for herpes be considered?

A

6 recurrences per year

significant anxiety due to diagnosis

35
Q

What are the recommended regimens for suppressive therapy for herpes?

A

Aciclovir 400 mg twice daily
Aciclovir 200 mg four times daily
Famciclovir 250 mg twice daily
Valaciclovir 500 mg once daily

36
Q

MALE Condom use reduces rate of transmission of herpes by what percentage?

A

50%

37
Q

Antivirals reduce asymptomatic viral shedding, by how much?

A

80-90% reduction

38
Q

When may auto inoculation occur with herpes infection?

A

first infection

compromised skin immunity eg eczema

39
Q

What complications may occur for a person immunocompromised with herpes infection eg HIV not on treatment?

A

severe, prolonged with risk of progressive, multifocal, and coalescing mucocutaneous anogenital lesions
potentially life-threatening systemic complications
- fulminant hepatitis
- pneumonia
- neurological disease
- disseminated infection

40
Q

In patients with advanced HIV and ano-genital herpes infection what change should be made to their antiviral medication? eg aciclovir

A

DOUBLE dose

5 day course may need EXTENDED

41
Q

In drug-resistant herpes in PWHIV what may be effective?

A

topical 1% foscarnet cream

topical 1% cidofovir gel

42
Q

What is the preferred treatment for drug-resistant herpes in PWHIV?

A

IV foscarnet or cidofovir

DipGUM (39 decks)

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