Herpes Simplex Virus 1 and 2

Question 1

What is the setup of a herpes virus?

Answer 1

Large, enveloped double stranded, DNA virus

Question 2

How many Human Herpes Viruses are there are name the three that dont go simply by their number

Answer 2

There are 8. Varicella-Zoster (3), EBV(4), CMV (5)

Question 3

What is the mode of transmission of herpes simplex?

Answer 3

Direct contact with infected secretions

Question 4

Where does herpes simplex replication take place?

Answer 4

Nucleus

Question 5

From what membrane does herpes simplex acquire its envelope?

Answer 5

Nuclear membrane

Question 6

The three classes of herpes simplex mRNA (in the order they appear) and what each does

Answer 6

Alpha - maybe controls latency, Beta - thymidine kinase and DNA pol, Gamma - viral strucutral components

Question 7

Give histological findings and spread of herpes simplex

Answer 7

Multi-nucleated giant cells, degeneration of epithelium, eosinophilic intranuclear inclusions, inflammation. Spreads cell to cell (often through neuronal networks)

Question 8

Do antivirals affect latent herpes simplex infection and why or why not?

Answer 8

No, because they target thymidine kinase or viral DNA pol (beta proteins) and latent cells do not produce viral beta or gammas

Question 9

Two theories of herpes simplex reactivation

Answer 9

Ganglionic theory (metabolic changes in neurons), and Skin trigger theory (local host immune changes)

Question 10

Which Herpes Simplex typically infects below the waist and which above the waist?

Answer 10

Type 1 - above the waist, Type 2 - below the waist

Question 11

Primary Herpes Simplex 1 infections are often asymptomatic. When symptomatic, what is the most common symptom?

Answer 11

Gingivostomatitis (esp 3-5 yr olds). Lasts 5-12 days

Question 12

Herpetic whitlow

Answer 12

Infection of finger or nail from herpes simplex 1. Vesiculating, pustular lesions

Question 13

If a patient has spread a HSV-1 infection to his eye, what should you not give him and why?

Answer 13

Topical steroids, they promote extension into deeper structures of the eye

Question 14

What is the most severe effect of HSV-1 infection and what is given to treat it?

Answer 14

Encephalitis, treat with IV acyclovir

Question 15

What is more likely to recur, an HSV-1 genital infection, or an HSV-2 genital infection?

Answer 15

HSV-2 genital infection

Question 16

Incubation period for primary genital HSV-2 infection

Answer 16

5 days following sexual contact

Question 17

Systemic manifestations of primary genital HSV-2 infection

Answer 17

Fever, malaise, myalgia, aseptic menigitis (rarely)

Question 18

How long do primary and recurrent genital HSV-2 infections last respectively?

Answer 18

Primary - 20 to 30 days, Recurrent - 10 to 14 days

Question 19

What is the median recurrence rate for genital HSV-2 infection?

Answer 19

4-5 episodes per year

Question 20

What typically causes neonatal herpes?

Answer 20

Contact with infected genital secretions of mother during delivery

Question 21

What is usually done to try and prevent perinatal HSV-2 infection in pregnant infected mothers?

Answer 21

C-section

Question 22

Tzanck Test

Answer 22

Smear from HSV-2 lesion stained with Giemsa or Papanicolaou may show intranuclear inclusions or multinucleated giant cells (requires expertise)

Question 23

In what viral infection are Owls eyes seen histologically?

Answer 23

CMV