HSV 1 and 2 Flashcards
HSV 1 is predominantly associated with
oral lesions
HSV 2 is predominantly associated with
genital lesions
transmission of HSV requires _________ and can happen when ____________
close contact
active outbreak or asymtpomatic
HSV is transmitted through inoculation of the virus onto ______
susceptible mucosal surface
HSV 1 is transmitted through
oral-to-oral contact (virus in saliva, sores, and surfaces in and around the mouth)
HSV 2 is transmitted via
sexual activity (oral-genital, genital-genital)
T or F: mother can transmit HSV to infant
T
cold sores are contagious from ______________ and are most contagious when _________
prodrome until lesion completely healed
blister bursts or leaks fluid
T or F: <50% of genital herpes are transmitted asymptomatically
F- up to 70% transmitted by asymp viral shedding
T or F: Asymptomatic shedding occurs in almost all patients with HSV-2
T
in initial infection with HSV, it replicates in cells of the _____ and infects ________
epithelium
nerve endings
HSV 1 stays in the _____ ganglia and HSV 2 in ______ ganglia
trigeminal
sacral
in HSV recurrence, viral replication is ________________, and spreads to mucosal surfaces through ________
reactivated in ganglion
peripheral sensory nerves
list 3 factors that may trigger HSV 1 recurrence
psychological stress, fatigue, viral illness (ex-cold/ influenza), exposure to UV light, local skin trauma, dental tx, menstruation, immune suppression
list 3 factors that may trigger HSV 2 recurrence
psychological stress, menstruation, local friction, surgery, immune suppression
most Gingivostomatitis infections are
subclinical
in first cases of HSV1, if you have sx, they are often
worse- multiple painful vesicles/ blisters and ulcerative erosions involving lips, oral cavity, pharynx, and perioral skin
healing from primary HSV1 takes
days to 2-3wks
first episode of HSV 1 is ______ severe than HSV 2
less severe
incubation of first episode genital herpes is ____ while lesions last _____
6d
11-12d
sx of 1st episode genital herpes
severe burning pain, itching, dysuria, vaginal or urethral discharge
describe the sx felt in prodromal epriod
tingling, discomfort, burning, itching 2-24hrs before appearance of the vesicle in location of the eruption
which type of HSV have higher % recurrence? HSV 1 or 2
2- 90% with sx primary HSV 2 can experience reactivation
recurrence of HSV 2 is often __ severe and ___ duration compared to primary episode
less severe, shorter duration
prodrome for HSV 1 usually ____ before lesions appear
2-24h
list 3 differential dx for HSV 1
Recurrent aphthous stomatitis (canker sores)
Chicken pox
Shingles (herpes zoster)
Oral cancers (basal cell carcinoma)
Angular cheilitis
Impetigo
Syphilis
refer for HSV 1 if
<12yrs,
lesions presents for >!4 days,
lesion appears infected (excessively swollen, red, or pus),
sx of systemic illness (fever, swollen glands),
compromised immune system d/t meds or disease,
frequent recurrences >6x/yr
tx for intermittent herpes labialis
topical or oral tx
choric suppressive tx for HSV 1 is appropriate for
appropriate for pts who are psychologically distressed (freq episodes or severe disease)
May be used to ↓ transmission to uninfected partners
Oral tx only
PO analgesics for mod-sevre HSV 1 pain
acetaminophen, ibuprofen, naproxen
topical analgesics for mild pain for HSV 1
benzocaine, camphor/ menthol/ phenol, lidocaine, pramoxine
how do protectants help in HSV 1
(Ex- petrolatum, zinc oxide, cocoa butter, allantoin, or calamine)- prevents cracking and excess drying of lips and lesion
T or F: astringents are recommended in cold sores
F- not rec due to excessive drying = cracking, fissuring, possible bacterial superinfection
zinc action in HSV may prevent ____________ but is known to be ______________
virus attachment to cells, not well studied
irritating and drying
heparin MOA for HSV 1
reduces binding of virus to cellular target in cell lines tested in lab- no published evidence for safety/ efficacy
propolis is a
resinous substances bees collect from plant sources
how to use coldsore-Fx
apply topically 4-6x/d until healed
what is the evidence for lysine in cold sores
may or may nor be effective, not much harm
Xerese decreases healing time and pain duration by
~0.5d
acyclovir ____ is not as effective as ____
ointment < cream
docosanol decreases healing time by ______ and pain duration by _________
0.5-1d
0.5d
which is false about docosanol
1. may help abort attacks
2. topical is more effective than oral docosanol
3. must be applied 5x/d
5. best chance of success if start at prodrome
2
which antivirals may be used in oral HSV
acyclovir, valacyclovir, famciclovir
evidence suggests using antivirals in primary HSV infections can
decrease disease duration + period of infectivity in children
which doses are expected to be higher for antivirals- in primary or recurrent HSV episodes
primary
intermittent suppressive tx for HSV is used when
outbreaks can be anticipated
T or F: the optimal dose and agent for intermittentsuppressive tx for HSV 1 is acyclovir 400mg BID 12-24hrs before exposure + continue through intense exposure
F- Optimal dose and pref antiviral agent unknown
intermittent suppressive tx for HSV may not impact lesions that
develop within 48hrs of UV exposure
which antiviral has the most data in pregancy
acyclovir
