HSV Flashcards
What is the presentation
primary infection: may present with a severe gingivostomatitis
cold sores
painful genital ulceration
What is the management of gingivostomatitis
Oral acyclovir and chlorhexadine mouthwash
What is the treatment for cold sores
topical aciclovir although the evidence base for this is modest
What is the management for genital herpes
Oral aciclovir
general measures include:
saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine
When is ceserean recommended
If a primary attack of herpes occurs during a pregnancy of 28 weeks=< gestation
What should be given to women with recurrent herpes
suppressive therapy during pregnancy
How does it present on a Pap smear
Multinucleated giant cells representing infection by the herpes simplex virus. Note the 3 M’s; Multinucleation, Margination of the chromatin, Molding of the nuclei
How does genital herpes present
Painful genital ulceration
dysuria and pruritis
the primary infection is often more severe than recurrent episodes
systemic features such as headache, fever and malaise are more common in primary episodes
tender inguinal lymphadenopathy
urinary retention may occur
What Is the investigation of choice
nucleic acid amplification tests (NAAT) is the investigation of choice in genital herpes and are now considered superior to viral culture
HSV serology may be useful in certain situations such as recurrent genital ulceration of unknown cause
What is herpes simplex keratitis
Dendritic corneal ulcer
What are the features of herpes simplex keratitis
red, painful eye
photophobia
epiphora
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer
What is the management of herpes keratitis
immediate referral to an ophthalmologist
topical aciclovir
where does herpes simplex encephalitis effect
virus characteristically affects the temporal lobes AND INFERIOR FRONTAL
What are the features of herpes encephalitis
Fever, headache, psychiatric symptoms, seizures, vomiting
focal features e.g. aphasia
peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis
What is the cause
HSV 1
What is the investigations For HSV E
CSF, PCR, CT, MRI, EEG
What is seen in CSF
lymphocytosis, elevated protein
What is seen on CT
medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients
What is seen on EEG
lateralised periodic discharges at 2HZ
How to treat HSV E
IV acyclovir
How does HSV Encephalitis it look on MRI
There is hyperintensity of the affected white matter and cortex in the medial temporal lobes and insular cortex.
