HSV

Question 1

Clinical manif

Answer 1

grouped vesicles arising on an erythematous base on keratinized skin or mucousmembrane

can be “atypical,”with patch(es)of erythema,small erosions, fissures,or subclinical lesions that shed HSV

Question 2

Etiology

Answer 2

Labialis: HSV-1 (80), HSV-2 (20%).
■ Urogenital: HSV-2 (80%), HSV-1 (20%).
■ Herpetic whitlow: HSV-1 (60%), HSV-2
(40%).
■ Neonatal: HSV-2 (80%), HSV-1 (20%

Question 3

lab test

Answer 3

Tsank smear :
Positive, acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes are detected.
Positive in 75% of early cases,either primary or recurrent.

Question 4

Confirmation of dx.

Answer 4

HSV infection confirmed by viral culture or antigen detection.

Question 5

Treatment

Answer 5

TOPICAL ANTIVIRAL THERAPY
Minimal efficacy.
Acyclovir5% ointment,apply 6 times daily or 7 days.
Penciclovir 1% cream every two hours while awake for recurrent orolabial in ection.

ORAL ANTIVIRAL THERAPY DRUGS
Acyclovir, valacyclovir,and famciclovir.
Valacyclovir,the prodrug of acyclovir,has a better bioavailability and is nearly85% absorbed after oral administration.
Famciclovir is equally effective for cutaneous HSV infections.
Acyclovir: 400 mg 3 times daily or 200 mg
5 times daily or 7 to 10 days.
Valacyclovir:1g twice daily for7 to 10 days for initial genital outbreak.
Famciclovir:250mg 3 times daily for 5 to 10 days.

RECURRENCES
Acyclovir:400mg three times daily or 5days.
Valacyclovir:1000mg twice daily for 5to 10days for genital HSV recurrence,2000mg twice daily or 1 day or labialis recurrence.
Famciclovir:1000mg twice daily or 1day for genital HSV recurrence, 1500mgx1 for labia- lis recurrence.
Continuous oral maintenance therapy (e.g. valaciclovir 500 mg/day) can be considered in patients with at least 6 episodes/year