Herpes Simplex Virus

Question 1

Define HSV

Answer 1

Oral, genital and ocular ulcers resulting from HSV-1 or HSV-2 infection

Question 2

What are the causes/risk factors of HSV?

Answer 2

Members of the human herpesvirus family (HHV-1/2) with dsDNA
After primary viral infection the virus becomes dormant (trigeminal or sacral root ganglia)
Reactivation may occur in response to physical or emotional stress or immunosuppression
• Close contact e.g. kissing, sexual
intercourse
• HIV infection
• Immunosuppression

HSV-1
• Herpes labialis
• Encephalitis
• Genital herpes

HSV-2
• Genital herpes

Question 3

What are the signs and symptoms of HSV?

Answer 3

Gingivostomatitis
• Pyrexia
• Anorexia
• Listlessness
• Gingivitis – markedly swollen, erythematous, friable gums
• Vesicular lesions -> ulcerated plaques
• Tender lymphadenopathy

Pharyngotonsillitis
• Fever
• Malaise
• Headache
• Sore throat
• Vesicular lesions -> ulcerated plaques
• Tender lymphadenopathy

Herpes labialis (cold sore) – reactivation
• Perioral tingling and burning
• Erythematous papules -> vesicles -> ulceration -> crusting

Genital herpes
• Fever
• Headache
• Malaise
• Myalgia
• Pain
• Itching
• Dysuria
• Vaginal and urethral discharge
• Vesicles -> pustules -> ulceration -> crusting
• Tender lymphadenopathy

Keratoconjunctivitis
• Epiphoria (watering eyes)
• Photophobia
• Dendritic ulcer visualised using 1% fluorescein

Question 4

What investigations are carried out for HSV?

Answer 4

• usually clinical diagnosis

* Vesicle fluid: Electron microscopy, PCR, direct immunofluorescence, growth of virus in tissue culture