Herpes Simplex Virus

Question 1

What are symptoms of oral herpes?

Answer 1

(herpes labialis) include tingling and burning followed by development of vesicular then ulcerative lesions involving the oropharynx and perioral mucosa

Question 2

What are symptoms of genital herpes?

Answer 2

range from asymptomatic to tingling and burning without lesions, to recurrent genital ulcerations

Question 3

What can help decrease severity and shorten duration?

Answer 3

Aciclovir, famciclovir, and valaciclovir

Question 4

How does daily suppressive therapy work?

Answer 4

reduces recurrences by 80% and reduces transmission risk by approximately 50%

Question 5

What is used to diagnose infection with or without lesions and distinguish between type 1 and 2?

Answer 5

Glycoprotein G-based type-specific serology testing

Question 6

What are RF for HSV?

Answer 6

HIV infection and immunosuppressive medications

Question 7

What is Sx for HSV?

Answer 7

1. Dysuria (women)
2. Lymphadenopathy
3. Genital ulcer
4. Oral ulcer

Question 8

What Ix are used in HSV?

Answer 8

1. HSV polymerase chain reaction (PCR)
2. Viral culture
3. Glycoprotein G-based type-specific serology (gG1 and gG2)

Question 9

What are DDx for HSV?

Answer 9

1. Syphillus
2. Chancroid
3. Contact dermatitis

Question 10

What is management for HSV?

Answer 10

1. Antivirals – acyclovir, valaciclovir, famciclovir
Oral
Topical (labialis)
2. If severe (disseminated):
IV
Hospitalisation
*Pregnant – prophylaxis, CS

Question 11

What do you use if HSV is acyclovir resistant?

Answer 11

Foscarnet

Question 12

What is the herpes virus?

Answer 12

family of double stranded linear DNA viruses

Question 13

What are the different types of herpes virus?

Answer 13

1. Herpes simplex virus
•	HSV 1, 2
2. Varicella Zoster virus
3. Epstein bar virus
4. Human cytomegalovirus
5. Human herpesvirus 6 (roseola)
6. Human herpesvirus 8 (Kaposi’s sarcoma)

Question 14

What are is transmission for HSV-1 and HSV-2 like?

Answer 14

• Sexual transmission
• Mucosal / skin breaks
• Vertical transmission (M  B)

Question 15

What are RF for HSV1 and HSV2?

Answer 15

Immunosuppression
• Medications
• HIV/AIDS

Question 16

What are RF for triggers of reccurence?

Answer 16

• Menstruation
• Stress
• Minor trauma
• Sun exposure

Question 17

What is the patho of HSV like?

Answer 17

1. Initial infection: retrograde movement
2. Latency: low level expression of viral genes
3. Reactivation: replication + anterograde movement

Question 18

What are features of herpes labialis?

Answer 18

1. Painful ulcers
2. High fever
3. Sore throat
4. Pharyngeal oedema
5. Myalgia
6. Cervical lymphadenopathy
7. If recurrent: pain, burning/tingling, vesicles

Question 19

What are features of genital herpes?

Answer 19

1. Ulceration, vesicles
2. Vulva, cervix, vagina, penis shaft/glands, perineum, buttocks
3. Genital pain
4. Dysuria
5. Fever
6. Neuralgia
7. Constipation, rectal pain, tenesmus, proctitis

Question 20

Can you have asymptomatic spreading?

Answer 20

1. Asymptomatic viral shedding of herpes simplex virus-1 and herpes simplex virus-2 can occur in most infected individuals. 2. risk of transmission is still much higher with contact with lesions.