Herpes Simplex Virus

Question 1

Define Herpes Simplex Virus?

Answer 1

Disease resulting from HSV1 or HSV2 infection

Question 2

What is the aetiology of Herpes Simplex?

Answer 2

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

Question 3

What is the pathophysiology of Herpes Simplex?

Answer 3

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

Question 4

What is the epidemiology of Herpes Simplex?

Answer 4

90% of adults are seropositive for HSV1 by 30 years
35% of adults > 60 years are seropositive for HSV 2
More than 1/3 of the world population have recurrent HSV infections

Question 5

What are the symptoms of HSV1 usually?

Answer 5

Primary Infection is often asymptomatic

Question 6

What are some possible symptoms of primary HSV1 infection?

Answer 6

Pharyngitis
Gingivostomatitis (eating might be painful)
Herpetic Whitlow

Question 7

What is Herpetic Whitlow?

Answer 7

Abscess at the end of the finger caused by infection with HSV - it is very painful

Question 8

What are symptoms of reactivation of HSV1?

Answer 8

Prodrome of perioral tingling and burning
Vesicles appear - they will ulcerate and crust over
Complete healing within 8-10 days

Question 9

What are symptoms of HSV2?

Answer 9

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

Question 10

What are symptoms of HSV encephalitits?

Answer 10

Usually caused by HSV1 so causes HSV1 type symptoms

Question 11

What are symptoms of HSV keratoconjunctivitis?

Answer 11

Watering Eyes

Photophobia

Question 12

What are signs of HSV1 primary infection on physical examination?

Answer 12

Tender cervical lymphadenopathy
Erythematous, oedematous pharynx
Oral Ulcers filled with yellow slough (gingivostomatitis)
Herpetic Whitlow

Question 13

What are signs of Herpes Labialis (reactivation affecting the mouth)?

Answer 13

Perioral vesicles/ulcers/crusting

Question 14

What are the signs of HSV2 on physical examination?

Answer 14

Maculopapular rash
Vesicles 
Ulcers
All of these are found on the external genitalia, anal margin and upper thighs
Inguinal Lymphadenoathy, pyrexia

Question 15

What are the signs of HSV2 Encephalitis on physical examination?

Answer 15

Signs of encephalitis

Question 16

What are the signs of HSV Keratoconjunctivitis?

Answer 16

Dendritic ulcer on the iris (better visualised with fluorescein)