Herpes Simplex

Question 1

Define Herpes Simplex

Answer 1

Infection with Herpes Simplex Virus, HSV-1 or HSV-2

Question 2

Aetiology of Herpes Simplex

Answer 2

Alpha herpes virus with ds-DNA
Transmission is via close contact with an individual e.g. kissing, sex

HSV can exist in a latent and lytic state.
During latency infectious virions are not produced.
Lytic infection is characterised by viral replication and transport of the virus to the skin -> herpes labialis (initial genital herpes)

Following primary viral infection the virus becomes dormant (classically in trigeminal or sacral root ganglia). Reactivation may occur in response to physical or emotional stresses or immunosuppression.

Question 3

Risk factors for Herpes Simplex

Answer 3

HIV infection
Immunosuppressive medication
High risk sexual behaviour
Female sex
Black race
Increasing age 
Lack of condom use

Question 4

Symptoms of Herpes Simplex (HSV-1)

Answer 4

Primary infection is often asymptomatic
Gingivostomatitis, cold sores (herpes labialis)
Herpetic whitlow
Eczema herpeticum
Herpes simplex meningitis
Women - dysuria
Genital ulcers (multiple painful ulcers | start as vesicular lesions -> ulceration -> crusted lesions)
Oral ulcers (single, recurrent, painful self-limited, along vermilion border)
Tingling sensation
Fever
Headache/aseptic meningitis

Temporal lobe encephalitis
Keratoconjunctivitis: Epiphoria (watering eyes), photophobia

Question 5

Symptoms of Herpes Simplex (HSV-2)

Answer 5

Very painful blisters and rash in the genital, perigenital and anal area
Dysuria
Fever
Malaise

Question 6

Signs of Herpes Simplex on examination

Answer 6

Lymphadenopathy
Genital ulcers (multiple painful ulcers | start as vesicular lesions -> ulceration -> crusted lesions)
Oral ulcer
(Single, recurrent, painful, self-limited ulcer along the vermilion border)

Question 7

Investigations for Herpes Simplex

Answer 7

Clinical diagnosis

Viral culture if lesions are present: Virus detected
HSV PCR: positive
gG1 and gG2: positive antibody to HSV-1 or HSV-2 (assesses risk in asymptomatic pregnant women for transmission)

Question 8

What are the other types of herpes viruses (except HSV)

Answer 8

HHV-3: VZV | respiratory transmission | chicken pox/shingles
HHV-4: EBV | kissing disease | mononucleosis
HHV-5: CMV | congenital, sexual, saliva transmission | mononucleosis
HHV-6+7: Saliva transmission | roseola infantum
HHV-8: sexual transmission | Kaposi sarcoma