Herpes Virus Infection

Question 1

Main cause of oral cold sores?

Answer 1

HSV-1

Question 2

Main cause of genital herpes?

Answer 2

HSV-2

Question 3

Treatment for Shingles is effective within what time frame?

Answer 3

72 hrs since symptom onset

Question 4

If a patient has shingles, when can they take the shingles vaccine?

Answer 4

After 1 year

Question 5

Shingrix

Answer 5

inactived vaccine, 2 doses 2-6 months apart

Question 6

Zostavax

Answer 6

live vaccine

Question 7

Treatment for varicella virus (chicken pox)?

Answer 7

acyclovir QID x 5-7 days
(initiate within 24 hrs of rash onset)

Question 8

How many days prior to lesions appearing is varicella virus contracted?

Answer 8

2 days prior.
generally takes 5-7 days for blisters to crust after appearing.

Question 9

For VZV, who requires acyclovir prophylaxis?

Answer 9

healthy patients at risk of mod-severe varicella virus: > 12 yo, pregnant, chronic cutaneous of pulmonary disorders, receiving long-term salicylate treatment, or short/intermittent course of oral or inhaled corticosteroids

Question 10

Treatment options for 1st episode of genital herpes? effective if started < 7 ds of onset

Answer 10

1. famciclovir 250 mg TID x 10 days
2. valacyclovir 1000 mg BID x 10 days
3. acyclovir 5 times/day x 5-10 days

Question 11

Treatment of shingles?

Answer 11

1. acyclovir 800 mg 5 times/day x 7 days
2. famciclovir 500 mg TID x 7 days
3. valacyclovir 1000 mg TID x 7 days

Question 12

Treatment for postherpetic neuraligia?

Answer 12

TCAs
gabapentinoids
SNRI (venla or duloxetinee)

Question 13

Postherpetic neuralgia

Answer 13

complication of shingles, nerve pain that persists after shingles rash is resolved, continues for weeks to years

Question 14

drug of choice for HSV encephalitis

Answer 14

acyclovir

Question 15

treatment for immunosuppressed pt + herpes zoster

Answer 15

acyclovir IV 10 mg/q8h x 8 days

Question 16

treatment for HSV keratoconjunctivitis for re-epithelialization of the cornea?

Answer 16

1st line: topical trifluridine - 1 drop q2h in cornea , then reduce to 1 drop q4h x 7 days

2nd line: idoxuridine - 1 drop q1h and q2h at night, indefinitely until improvement. continue x 5-7 days even after healing (but dont exceed 21 days)

Question 17

If a patient is taking an immunosuppressant or biologic, and wants Zostavax vaccine, how long to wait before administration?

Answer 17

stop biologic if no current flare up, then administer zostavax after 2 MONTHS

Question 18

Live herpes zoster vaccine is considered safe to administer to patients
receiving low-dose immunosuppressive therapy such as…

Answer 18

1. methotrexate ≤0.4 mg/kg/week
2. azathioprine ≤3.0 mg/kg/day
3. 6-mercaptopurine ≤1.5 mg/kg/day
4. prIf aednisone <20 mg/day (or equivalent)

Question 19

If a patient already received Zostavax (live), can they receive Shingrix?

Answer 19

Yes, if they are 65+ years old, they can get Shingrix after 5 years of Zostavax

Question 20

How many doses of Zostavax?

Answer 20

1 dose over 50 years old

Question 21

How many doses of Shingrix?

Answer 21

2 doses, 2-6 months apart

Question 22

when is suppressive antiviral management initiated in pregnancy for genital herpes?

Answer 22

36 weeks

Question 23

What are some factors that can increase risk for genital herpes?

Answer 23

stress
systemic lupus (or immunosuppression)
female
unprotected sex/multiple partners