Herpes Simplex Virus

Question 1

What type of virus is HSV?

Answer 1

Double-stranded DNA virus

Question 2

What are the two main types of HSV?

Answer 2

• HSV-1
• HSV-2

Question 3

What does HSV-1 manifest as?

Answer 3

Oral herpes (cold sores)

Question 4

What does HSV-2 manifest as?

Answer 4

Genital herpes

Question 5

How is HSV transmitted?

Answer 5

Direct contact with infected secretions or lesions

Question 6

What are the clinical features of genital herpes?

Answer 6

• Painful genital ulceration
• Dysuria (may or may not be present)
• Itching
• Primary infection is worse than recurrent episodes
• More systemic symptoms in primary infection (e.g. headache, fever, malaise)
• Tender inguinal lymphadenopathy

Question 7

What investigations are used for genital herpes?

Answer 7

• NAAT
• HSV serology

Question 8

What is the general management for genital herpes?

Answer 8

• Saline baths
• Analgesia
• Topical anaesthetics (e.g. lidocaine)
• Oral acyclovir

Question 9

What is the management for pregnant women with a primary attack of HSV?

Answer 9

Elective c-section if primary attack of HSV >28 weeks gestation

Question 10

What is keratitis?

Answer 10

Inflammation of the cornea

Question 11

What is the most common cause of keratitis?

Answer 11

Herpes simplex virus infection

Question 12

What are the clinical presentations of primary herpes keratitis?

Answer 12

• Mild symptoms
• Blepharoconjunctivitis

Question 13

What are the clinical presentations of recurrent herpes keratitis?

Answer 13

• Painful red eye
• Photophobia
• Vesicles (fluid-filled blisters)
• Foreign body sensation
• Watery discharge
• Reduced visual acuity

Question 14

What investigations are used for herpes keratitis?

Answer 14

• Slit lamp examination
• Fluorescein staining (shows dendritic ulcer)
• Corneal scrapings

Question 15

What is the management for herpes keratitis?

Answer 15

• Urgent assessment from ophthalmologist
• Topical or oral antivirals
• Corneal transplant

Question 16

What brain region is herpes encephalitis characteristically associated with?

Answer 16

Temporal lobes

Question 17

What is the most common type of HSV causing herpes encephalitis?

Answer 17

HSV-1

Question 18

What are the clinical features of herpes encephalitis?

Answer 18

• Fever
• Headache
• Seizures
• Nausea and vomiting
• Focal features (e.g. aphasia)

Question 19

What investigations are used for herpes encephalitis?

Answer 19

• CSF (lymphocytosis)
• PCR (HSV)
• CT (temporal +/- frontal lobe changes, e.g. petechial haemorrhage)

Question 20

What is the management for herpes encephalitis?

Answer 20

IV acyclovir