HSV Flashcards
Management of patient who delivers at term with primary HSV in 1st/2nd trimester
Aciclovir 400mg TDS from 32/40 then vaginal delivery
Management of patient who delivers at term with primary HSV in 3rd trimester but no vesicles at birth
Aciclovir 400mg TDS from diagnosis or 32/40 and C section
Management of patient who presents at term with primary HSV diagnosed at presentation for delivery
C section, consider intrapartum aciclovir, high risk neonate
Baby born to mum by SVD. Mum develops primary HSV 2 weeks following birth. Investigation and management of child?
Highest risk - send Blood, swabs (skin, conjunctivae, nose, rectum, mouth) and CSF. Treat empirically. 10 days negative results (14 days SEM, 21 days CNS/disseminated)
Management of patient who has HSV infection prior to pregnancy. No lesions in pregnancy or at time of delivery.
Prophylactic aciclovir from 32/40 and SVD.
Management of patient with non primary HSV who is felt to represent a high risk of pre term delivery.
Prophylactic aciclovir 400md BD from “at risk” period until 32/40 then 400mg TDS. normal SVD.
Proportion of neonatal HSV infections that are postnatal?
10-25%
3 presentations of neonatal HSV and proportions
1/3 each
- SEM (skin, eyes, mouth)
- CNS
- Disseminated
Highest risk neonate for HSV infection, investigations and management.
Criteria
- Symptomatic HSV
- Pos HSV testing
- SVD and primary HSV infection at time of birth
- Postpartum infection of mum up to 4/52
Investigation
- Swabs - conjunctivae, mouth, skin, rectum
- Blood PCR
- CSF PCR
Mgmt
- Empiric - 10 days
- SEM - 14 days
- CNS/disseminated - 21 days with CSF/bood recheck at end of Rx. If Pos then continue 1 more week.
High risk neonate criteria, investigation and mgmt.
Criteria
- Primary HSV in the 6 weeks prior to delivery regardless of delivery method
Investigation
- Swabs - conjunctivae, mouth, skin, rectum
- Blood PCR
- CSF PCR
Mgmt
- Empiric - 10 days
- SEM - 14 days
- CNS/disseminated - 21 days with CSF/bood recheck at end of Rx. If Pos then continue 1 more week.
Low risk neonate criteria, investigation, mgmt
Criteria
- Asymptomatic baby born by any method to mum with non-primary HSV lesions at delivery
- Asymptomatic babies born at<37 weeks by any delivery method with no active lesions at delivery and a history of HSV infection more than 6 weeks previously
Investigation
- Swabs - conjunctivae, mouth, skin, rectum
- Blood PCR
- Note CSF not routinely recommended.
Mgmt
- monitor. If any evidence HSV then manage as per symptomatic (highest risk)
Lowest risk neonate criteria, investigation, mgmt
Criteria
- Asymptomatic babies born at >37 weeks by any delivery method with with no active lesions in birthing woman or person at delivery AND a history of HSV infection more than 6 weeks previously
Investigation
- no empiric investigations
Mgmt
-monitor for 24h then home
Treatment of patient who delivers via SVD at term with primary HSV diagnosed at delivery
intrapartum aciclovir. Neonate represents highest risk
HSV
- Baltimore class
- Enveloped/non enveloped
Linear dsDNA - Class 1
Enveloepd
HSV presentations - immunocompotent adults
- Skin - coldsore, genital, exzema herpeticum, herpetic whitlow
- eyes - dendritic ulcer
- meningitis - mainly HSV2
- Encephalitis - Mainly HSV1
