Herpes Simplex Virus

Question 1

Definition

Answer 1

Disease resulting from HSV1 or HSV2 infection

Question 2

Aetiology

Answer 2

• Transmitted via close contact (e.g. kissing, sexual intercourse) with an individual that is shedding the virus

Question 3

Pathophysiology

Answer 3

o After primary infection, the virus will become dormant (within nerve ganglia)
o Reactivation may occur in response to physical and emotional stresses or
immunosuppression
o The virus causes cytolysis of infected epithelial cells leading to vesicle formation

Question 4

Epidemiology

Answer 4

• 90% of adults are seropositive for HSV1 by 30 yrs
• 35% of adults > 60 yrs are seropositive for HSV2
• More than 1/3 of the world population have recurrent HSV infections

Question 5

Presenting symptoms (HSV1)

Answer 5

• HSV1 - primary infection is often asymptomatic

• Possible symptoms of primary HSV1 infection:
o Pharyngitis
o Gingivostomatitis (eating might be painful)
o Herpetic whitlow (abscess at the end of the finger caused by infection with HSV - it is very painful)

• Symptoms of reactivation of HSV1:
o Prodrome of perioral tingling and burning
o Vesicles appear - they will ulcerate and crust over
o Complete healing within 8-10 days

Question 6

Presenting symptoms (HSV2)

Answer 6

o Painful blisters and rash in the genital, perigenital and anal area
o Dysuria
o Fever
o Malaise

Question 7

Presenting symptoms (HSV encephalitis)

Answer 7

o Usually caused by HSV1 so causes HSV1 type symptoms

Question 8

Presenting symptoms (HSV keratoconjunctivitis)

Answer 8

o Watering eyes

o Photophobia

Question 9

Signs on physical examination (HSV1)

Answer 9

• HSV1 Primary Infection
o Tender cervical lymphadenopathy
o Erythematous, oedematous pharynx
o Oral ulcers filled with yellow slough (gingivostomatitis)
o Herpetic whitlow

Question 10

Signs on physical examination (herpes labialis)

Answer 10

Herpes Labialis (reactivation affecting the mouth)
o Perioral vesicles/ulcers/crusting

Question 11

Signs on physical examination (HSV2)

Answer 11

o Maculopapular rash
o Vesicles
o Ulcers
o All of these are found on the external genitalia, anal margin and upper thighs
o Others: inguinal lymphadenopathy, pyrexia

Question 12

Signs on physical examination (HSV encephalitis)

Answer 12

o Signs of encephalitis

Question 13

Signs on physical examination (HSV keratoconjunctivitis)

Answer 13

o Dendritic ulcer on the iris (better visualised with fluorescein)

Question 14

Investigations

Answer 14

• Diagnosis is usually CLINICAL

* Vesicle fluid can be sampled and sent for electron microscopy, PCR