HSV & HPV Flashcards
Definition of Herpes Simplex Virus (HSV)
- mucocutaneous infection of the mouth and lips caused by HSV
- Commonly seen on the lips of people but can occur anywhere in the mouth or perinasally
What is HSV commonly referred to as?
Cold sores
Fever blisters
Herpes labialis
Where does it commonly occur on the lips?
Vermillion border
What is HSV infection commonly associated with?
Increased risk of constitutional symptoms
i.e. fever, malaise, sore throat, myalgia, inability to eat, irritability, cervical adenopathy, and gingivostomatitis for 3-14 days
What are the two types of herpes?
HSV1 and HSV2
Causes of HSV?
- Contracted by touching infected saliva, mucous membranes, or skin
- highly contagious
- new outbreaks can be affected by illness, stress, fatigue
What is Stage 1 of HSV?
Primary infection
- virus enters through small cracks in skin or mucous membranes and replicates
- oral sores and other symptoms may develop
- may be asymptomatic
What is Stage 2 of HSV?
Latency
- from the infected site virus moves to the dorsal root ganglia
- reporduces usually without symptoms and becomes inactive
- reactivated by certain conditions
What is Stage 3 of HSV?
Recurrence
- Reactivated by certain emotional or physical stresses
i. e. stress, UV light, Fatigue, fever, hormones, immune depression, trauma
Signs and symptoms of HSV
INCUBATION period- 2-12 days between contact and appearance of symptoms (average is 4 days)
DURATION- Signs and symptoms will last 2-3 weeks
- pain, burning, tingling, and itching occurs at site before sore appears
- cluster of vesicles erupts and breaks down rapidly
- crusting of vesicles occurs a few days later
HSV of pharynx appearance
in exudative or ulcerative lesions of posterior pharynx or tonsillar pillars
Difficult to distinguish from strep pharyngitis
Possible DDX you need to R/O
Impetigo, so culture
Diagnosis of HSV
- Usually made clinically
- Viral culture
- throat culture
- HSV 1 and HSV2 serology
- Tzanck Smear
What do you see on a Tzanck smear for HSV?
Multinucleated giant cells
How do you treat HSV?
oral anti-viral
- tx when first feel prodrome
What is a good Tx of HSV for patients afraid of oral agents
Topical agents, they aren’t as effective
-there is a moderate benefit at best with Acyclovir based topicals
see a slight decrease in duration of pain and viral shielding
What do oral HPV infections cause
Genital warts, and cervical cancer
-increasingly recognized in oral infections including base of tongue and tonsils
Epidemiology of HPV
Men > women
HPV16 most frequent subtype
Transmitted via sexual contact
Smoker > non-smokers
Signs and symptoms of HPV
Most have no symptoms
- earliest sign is painful swallowing
- late signs are hemoptysis, lump on neck or in cheek, hoarseness that doesn’t go away, earache, unexplained weight loss, lymphadenopathy
Prevention of HPV
-Sexual abstinence (dental dams, barrier contraceptives)
Vaccine for HPV
They are prophylactic and don’t treat an existing infection
CDC recommends:
Women/girls: 11-26 years old.
Men/boys: 9-26 years old
Treatment for HPV
Excision and biopsy of all lesions
Tx then based on biopsy findings
Radiation and chemotherapy
patient education is important
Complication of HPV
- > 50% in head/neck CA
