Herpes Simplex Virus Flashcards
What are the seroprevalence rates of HSV-1 and HSV-2 among persons aged 14 to 49 years in the United States?
HSV-1: 47.8%, HSV-2: 11.9%
These rates indicate the prevalence of these viruses in a significant age group.
What is the primary cause of recurrent genital herpes?
HSV-2
Although HSV-1 is increasingly causing first-episode genital herpes.
What percentage of first-episode genital herpes is caused by HSV-1 in certain populations?
Up to 70%
Particularly noted in young adult women and men who have sex with men.
What is the relationship between HSV-2 infection and HIV acquisition risk?
Increases the risk two- to three-fold
This is due to the immunocompromised state associated with HSV-2.
What are the classic manifestations of oral HSV-1 infection?
Sensory prodrome, lesions on lips and oral mucosa evolving from papule to vesicle, ulcer, and crust
The course of illness lasts 5 to 10 days.
What are the typical local symptoms associated with genital herpes?
Sensory prodrome, pain, pruritus, dysuria, and vaginal or urethral discharge
Inguinal lymphadenopathy is also common, especially in primary infection.
True or False: Genital HSV-1 infections typically have more recurrences than genital HSV-2 infections.
False
Recurrences and viral shedding occur less often with genital HSV-1 infections.
What is the preferred laboratory method for diagnosing mucocutaneous HSV infections?
HSV DNA polymerase chain reaction (PCR)
PCR is the most sensitive method for diagnosis.
What should be considered when counseling a patient diagnosed with HSV-2?
Risk of transmitting infection to sex partners
Counseling guidelines are provided in CDC STD Treatment Guidelines.
Fill in the blank: Consistent use of _______ reduces HSV-2 acquisition among heterosexual couples.
latex condoms
This is important for preventing transmission of HSV-2 and other STIs.
What antiviral therapy can reduce HSV-2 transmission to susceptible partners by 48%?
Suppressive antiviral therapy (e.g., valacyclovir 500 mg once daily)
This applies to HSV-2 seropositive persons with symptomatic genital herpes.
What is the recommended treatment duration for first episodes of genital HSV?
7 days to 10 days
Recurrences can be treated for 5 to 10 days.
What is the treatment of choice for acyclovir-resistant HSV?
IV foscarnet
IV cidofovir is a potential alternative.
What is the effect of suppressive therapy with antiviral drugs on HIV progression?
Does not delay HIV progression
Antiviral regimens for herpes should not replace ART.
What is the risk associated with HSV acquisition late in pregnancy?
Higher risk of neonatal HSV transmission
This is particularly a concern for HSV-2-seropositive pregnant women.
True or False: Acyclovir is considered safe for use during pregnancy, especially in the second and third trimesters.
True
It has the most reported experience in pregnancy.
What should be monitored in patients receiving high-dose IV acyclovir?
Renal function
Monitoring should be done at initiation and once or twice weekly during treatment.
What is the primary concern with HSV during pregnancy?
Potential for transmission to the fetus or neonate
This can have serious consequences, including fatal outcomes.
What does suppressive therapy with oral acyclovir, valacyclovir, or famciclovir effectively prevent?
Recurrences of HSV lesions
It is particularly preferred for patients with severe or frequent recurrences.
What antiviral drugs are mentioned as safe and well tolerated during pregnancy?
Valacyclovir and famciclovir
These drugs are particularly noted for their use in the third trimester.
What is the predominant risk factor for neonatal HSV transmission during delivery?
Maternal genital shedding of HSV at delivery
This is a critical factor in the potential transmission of HSV to the neonate.
When is cesarean delivery recommended for women with genital herpes?
When there is a genital herpes prodrome or visible HSV genital lesions at the onset of labor
This recommendation aims to reduce the risk of neonatal HSV transmission.
What is the recommended suppressive therapy for pregnant women with recurrences of genital herpes?
Suppressive therapy with either valacyclovir or acyclovir starting at 36 weeks’ gestation
This is recommended for managing recurrences during pregnancy.
What is the dosing regimen for treating orolabial lesions?
Valacyclovir 1 g PO twice a day, Famciclovir 500 mg PO twice a day, or Acyclovir 400 mg PO three times a day
Duration of treatment is 5–10 days.
What is the treatment duration for initial genital lesions?
7–10 Days
This is the recommended duration for initial genital lesions.
What constitutes chronic suppressive therapy for HSV?
Valacyclovir 500 mg PO twice a day, Famciclovir 500 mg PO twice a day, or Acyclovir 400 mg PO twice a day
This is for patients with severe recurrences or those who wish to minimize recurrence frequency.
What is the preferred therapy for acyclovir-resistant mucocutaneous HSV infections?
IV Foscarnet 80–120 mg/kg/day in 2–3 divided doses until clinical response
This therapy is recommended for managing resistant infections.
Fill in the blank: Suppressive therapy is not recommended for women who are seropositive for HSV-2 but have _______.
no history of genital lesions
True or False: Neonatal HSV disease has been reported in infants born to women treated with antenatal suppressive antiviral therapy.
True
This indicates that while therapy is beneficial, it may not eliminate all risks.
What is the treatment for severe mucocutaneous HSV infections?
Acyclovir 5 mg/kg IV every 8 hours, then switch to oral therapy as lesions regress
Continue treatment until lesions have completely healed.
How often should the need for suppressive therapy be evaluated?
Annually
Regular evaluation helps determine ongoing necessity.
What is the alternative therapy for acyclovir-resistant mucocutaneous HSV infections?
IV cidofovir 5 mg/kg once weekly or topical formulations
Topical formulations include trifluridine, cidofovir, imiquimod, and foscarnet.
