Herpes Simplex Infections

Question 1

What is herpes simples?

Answer 1

Common viral infection presenting with localised blistering

Question 2

Clinical features of herpes simplex infections

Answer 2

Primary infection: may present with a severe gingivostomatitis

Cold sores

Painful genital ulceration

Question 3

Management of herpes simplex infections

Answer 3

Gingivostomatitis: oral aciclovir, chlorhexidine mouthwash

Cold sores: topical aciclovir although the evidence base for this is modest

Genital herpes: oral aciclovir

Question 4

Presentation of herpes simplex keratitis

Answer 4

Most commonly presents with dendritic corneal ulcer

Question 5

Clinical features of herpes simplex keratitis

Answer 5

Red, painful eye

Photophobia

Epiphora

Visual acuity may be decreased

Fluorescein staining may show an epithelial ulcer

Question 6

Management of herpes simplex keratitis

Answer 6

Immediate referral to ophthalmology

Topical aciclovir

Question 7

Clinical features of herpes simplex encephalitis

Answer 7

Fever, headache, psychiatric symptoms, seizures, vomiting

Focal features e.g. aphasia (temporal lobe signs)

Peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis

Question 8

Investigations in herpes simplex encephalitis

Answer 8

CSF:lymphocytosis, elevated protein

PCR for HSV

CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients

MRI is better

EEG pattern: lateralised periodic discharges at 2 Hz

Question 9

Management of herpes simplex encephalitis

Answer 9

IV aciclovir