Herpes Simplex Virus

Question 1

treatment for genital herpes ?

Answer 1

oral acyclovir

Question 2

features of herpes simplex encephalitis on CT ?

Answer 2

medial temporal and inferior frontal changes e.g. petechial haemorrhages

normal in 1/3 patients

Question 3

features of herpes simplex encephalitis on LP?

Answer 3

lymphocytosis

elevated protein

Question 4

investigations if you suspect encephalitis ?

Answer 4

LP
CT head (or MRI)
PCR of HSV
EEG

Question 5

treatment for HSV encephalitis ?

Answer 5

IV acyclovir

Question 6

what area of the brain does HSV encephalitis typically affect ?

Answer 6

temporal and inferior frontal lobes

Question 7

1st line treatment for shingles ?

Answer 7

oral acyclovir

Question 8

who is the shingles vaccine offered to ?

Answer 8

all patients from 70-79 yrs

Question 9

what is a contraindication to shingles vaccine ?

Answer 9

immunosuppression because it is a live attenuated vaccine

Question 10

features of herpes zoster ophthalmicus ?

Answer 10

vesicular rash around the eye which may or may not involve the eye itself

hutchinson’s sign:

• rash on the tip or side of the nose
• indicates nasocillary involvement
• strong risk factor for ocular involvement

Question 11

treatment for herpes zoster ophthalmicus ?

Answer 11

oral antiretroviral therapy for 7-10 days

• IV if severe or immunocompromised
• ideally start within 72 hours

topical steroids for secondary inflammation of the eye

ocular involvement = urgent ophthalmology review

Question 12

features of herpes simplex keratitis ?

Answer 12

most commonly presents with dendritic corneal ulcer

red, painful eye 
photophobia
epiphora (excessive tearing)
visual acuity may be decreased
fluorescent staining may show epithelial ulcer