Herpes Simplex Virus

Question 1

What are the two strains of herpes simplex virus in humans?

Answer 1

HSV-1: previously typically oral lesions but now most common cause of genital herpes in UK
HSV-2: previously typically genital lesions but now more likely to cause recurrent anogenital symptoms

(however considerable overlap)

Question 2

What are some types of herpes simplex virus?

Answer 2

Primary infection: severe gingivostomatitis
Cold sores
Painful genital ulceration

Question 3

What is the management of gingivostomatitis herpes?

Answer 3

Oral acyclovir
Chlorhexidine mouthwash

(helps frequency and severity of symptoms but doesn’t cure)

Question 4

What is the management of cold sores?

Answer 4

Topical aciclovir

(helps frequency and severity of symptoms but doesn’t cure)

Question 5

What is the management of genital herpes?

Answer 5

Oral aciclovir 400mg 5/7
(helps frequency and severity of symptoms but doesn’t cure)

Symptomatic treatment (painkillers, saline bathing, local anaesthetic gel, topical lidocaine 5% ointment)

Avoid all sexual contact during outbreak

Question 6

When and how is most herpes simplex virus acquired?

Answer 6

Childhood (70% of UK adults infected)
Transmitted via oral secretions during close contact

Question 7

What can trigger latent herpes simplex virus reactivation from the trigeminal ganglion?

Answer 7

Stress
Trauma
Febrile illness
UV radiation

Question 8

What are some investigations for herpes simplex virus?

Answer 8

Swab of lesion via transport medium for PCR

Question 9

What is the pathophysiology of herpes simplex virus?

Answer 9

After infection virus travels up nearest nerve to ganglion and remains formant there
During reactivation it travels back down nerve onto surface of skin and causes symptomatic outbreak

Question 10

What are some clinical features of genital herpes infection?

Answer 10

Painful blistering and ulceration
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia

Question 11

What is the management of herpes simplex virus in pregnancy?

Answer 11

Elective C-section at term if primary attack of herpes occurs during pregnancy greater than 28 weeks gestation
Recurrent herpes that’s treated with suppressive therapy should be advised that risk of transmission to baby is low