Herpes simplex virus

Question 1

What is Herpes simplex virus?

Answer 1

Disease resulting from HSV1 or HSV2 infection

Question 2

How is HSV transmitted?

Answer 2

Via close contact (e.g. kissing, sex) with individual shedding the virus

Question 3

Summarise the epidemiology of herpes simplex

Answer 3

90% of adults seropositive for HSV1 by 30
35% of adults > 60 seropositive for HSV2
> 1/3 of world population have recurrent HSV infections

Question 4

List 3 symptoms of HSV 1

Answer 4

Primary infection is often asymptomatic
Pharyngitis
Gingivostomatitis (eating might be painful)
Herpetic whitlow (abscess at end of finger- very painful)

Question 5

List 4 symptoms of HSV2

Answer 5

Painful blisters + rash in genital, perigenital + anal area
Dysuria
Fever
Malaise

Question 6

List 4 signs of HSV1 primary infection

Answer 6

Tender cervical lymphadenopathy
Erythematous, oedematous pharynx
Oral ulcers filled with yellow slough (gingivostomatitis)
Herpetic whitlow (digital blisters)

Question 7

What is the name of reactivation of HSV1? What sign may this cause?

Answer 7

Herpes Labialis “cold sore”
Prodrome perioral tingling + burning
Perioral vesicles/ ulcers/ crusting

Question 8

investigations for herpes simplex

Answer 8

Diagnosis is usually CLINICAL

Vesicle fluid can be sampled + sent for electron microscopy, PCR

Question 9

Describe the Pathophysiology of HSV

Answer 9

After primary infection, HSV becomes dormant (within nerve ganglia)
Reactivation may occur in response to physical + emotional stresses or immunosuppression
Virus causes cytolysis of infected epithelial cells leading to vesicle formation

Question 10

How does HSV encephalitis present?

Answer 10

Usually caused by HSV1 so causes HSV1 type symptoms

Question 11

Give 2 symptoms of HSV keratoconjunctivitis

Answer 11

Watering eyes

Photophobia

Question 12

List 5 signs of HSV2

Answer 12

Maculopapular rash 
Vesicles  
Ulcers
On the external genitalia, anal margin + upper thighs  
Inguinal lymphadenopathy
Pyrexia