HSV 2014 Flashcards
What is most common cause of genital HSV uk?
HSV 1 (used to be HSV 2)
How many people will be symptomatic at time of acquisition HSV 2?
1/3
In this minority incubation is 2 days-2weeks
How does the body deal with HSV?
Following primary infection virus becomes latent in local sensory ganglia-periodically reactivating to cause symptomatic lesions or asymptomatic but infectious shedding
What is median recurrence rate HSV 2?
4 recurrences per year
How does HIV affect HSV?
Both symptomatic and asymptomatic shedding increased
What complications may be seen with HSV?
Secondary infection
Autonomic neuropathy (retention)
Autoinnoculation
Aseptic meningitis
What is best test HSV?
NAAT
When might antibody serology help?
Pregnant women-to try and determine if recent or established infection using IgG (IgM unreliable)
How do you manage primary infection?
Saline bathing
Analgesia
5% lidocaine ointment
Aciclovir if <5 days or new lesions or persistent systemic symptoms-to reduce the severity and duration of current episode.
What is recommended regimen for antivirals?
All 5 days
-but ? Continue if new lesions/complications/systemic still)
Preferred
Aciclovir 400mg tds
Valaciclovir 500mg bd
Alternative:
Aciclovir 200mg x 5 daily
Famciclovir 250mg tds
What are options for episodic treatment of recurrent HSV?
Aciclovir 800mg tds 2 days
Famciclovir 1g bd 1 day
valaciclovir 500mg bd 3/7
Will reduce severity/duration of disease, may abort lesions with early rx
Short course more convenient and cost effective.
2nd line 5 day treatments
Who should start suppressive antiviral?
Balance of frequency/cost/inconvenience of treatment-subjective. Trials were done on 6 recurrences a year but likely will reduce recurrence in all.
If significant anxiety associated may benefit.
What monitoring is needed for suppressive rx?
None. Safe.
Reduce dose if severe renal disease.
What are recommended regimens for suppressive treatment?
Aciclovir 400mg bd or 200mg qds
Famciclovir 250mg bd
Valaciclovir 500mg od
If breakthrough recurrence increase dose.
Depends on compliance/cost
Needs to stop after a year and reassess frequency (await 2 recurrences as often rebound recurrence on cessation)
Who should be treated empirically for HSV without lesions?
MSM symptomatic proctitis
Source of support?
HSV association helpline/leaflet
What to tell people re transmission/disclosure?
Avoid sex during prodrome or if lesions
Transmission can occur if asymptomatic
Condoms may help
Suppressive antivirals may help
Avoid transmission to pregnant people
Disclosure always advised
What are the different aciclovir doses for treatment/episodic/supression?
Treatment: 400mg tds 5 days
Episodic: 800mg tds 2 days
Suppressive: 400mg bd daily
How do you manage rec hsv in pregnancy? (All trimester)
Treat episode if need
Suppressive aciclovir 400mg tds from 36/40
Vaginal delivery fine
If lesion at delivery (only) observe 24hrs
How do you manage first infection hsv before third trimester?
Treat episode
36/40 400mg tds aciclovir
Vaginal del fine
If lesions at del (only) observe baby 24hrs
How do you treat first hsv third trim?
Treat episode
Continue with supressive until delivery -recommend CS-esp if <6weeks
If CS
Observe 24 hrs
Inform paeds but nil to do if well
If NVD ensues
Inform paeds
If well-aciclovir 20mg/kg 10/7 a/w swabs
If unwell LP plus swabs and treat
