HSV

Question 1

Management of patient who delivers at term with primary HSV in 1st/2nd trimester

Answer 1

Aciclovir 400mg TDS from 32/40 then vaginal delivery

Question 2

Management of patient who delivers at term with primary HSV at the start of the 3rd trimester but no vesicles at birth

Answer 2

Aciclovir 400mg TDS from diagnosis or 32/40 and C section

Question 3

Management of patient who presents at term with primary HSV diagnosed at presentation for delivery

Answer 3

C section, consider intrapartum aciclovir, high risk neonate

Question 4

Baby born to mum by SVD. Mum develops primary HSV 2 weeks following birth. Investigation and management of child?

Answer 4

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)

Question 5

Management of patient who has HSV infection prior to pregnancy. No lesions in pregnancy or at time of delivery.

Answer 5

Prophylactic aciclovir from 32/40 and SVD.

Question 6

Management of patient with non primary HSV who is felt to represent a high risk of pre term delivery.

Answer 6

Prophylactic aciclovir 400md BD from “at risk” period until 32/40 then 400mg TDS. normal SVD.

Question 7

Proportion of neonatal HSV infections that are postnatal?

Answer 7

10-25%

Question 8

3 presentations of neonatal HSV and proportions

Answer 8

1/3 each
- SEM (skin, eyes, mouth)
- CNS
- Disseminated

Question 9

Highest risk neonate for HSV infection, investigations and management.

Answer 9

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.

Question 10

HSV high risk neonate criteria, investigation and mgmt.

Answer 10

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.

Question 11

Low risk neonate criteria, investigation, mgmt

Answer 11

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)

Question 12

Lowest risk neonate criteria, investigation, mgmt

Answer 12

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

Question 13

Treatment of patient who delivers via SVD at term with primary HSV diagnosed at delivery

Answer 13

intrapartum aciclovir. Neonate represents highest risk

Question 14

HSV
- Baltimore class
- Enveloped/non enveloped

Answer 14

Linear dsDNA - Class 1
Enveloepd

Question 15

HSV presentations - immunocompotent adults

Answer 15

NAME?

Question 16

Diagnosis - recurrent HSV 2 meningitis

Answer 16

Mollaret’s meningitis

Question 17

Factors associated with worse outcomes in neonatal HSV infection

Answer 17

HSV2
Premature (no transplacental AB transfer)
Disseminated disease
Delay in treatment

Question 18

Management of patient who has HSV infection prior to pregnancy and who is found to have lesions at presentation for delivery at term.

Answer 18

SVD. Baby represents low risk. No empiric ix. Monitor for 24h