HSV & HPV

Question 1

Definition of Herpes Simplex Virus (HSV)

Answer 1

• 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

Question 2

What is HSV commonly referred to as?

Answer 2

Cold sores
Fever blisters
Herpes labialis

Question 3

Where does it commonly occur on the lips?

Answer 3

Vermillion border

Question 4

What is HSV infection commonly associated with?

Answer 4

Increased risk of constitutional symptoms

i.e. fever, malaise, sore throat, myalgia, inability to eat, irritability, cervical adenopathy, and gingivostomatitis for 3-14 days

Question 5

What are the two types of herpes?

Answer 5

HSV1 and HSV2

Question 6

Causes of HSV?

Answer 6

• Contracted by touching infected saliva, mucous membranes, or skin
• highly contagious
• new outbreaks can be affected by illness, stress, fatigue

Question 7

What is Stage 1 of HSV?

Answer 7

Primary infection

• virus enters through small cracks in skin or mucous membranes and replicates
• oral sores and other symptoms may develop
• may be asymptomatic

Question 8

What is Stage 2 of HSV?

Answer 8

Latency

• from the infected site virus moves to the dorsal root ganglia
• reporduces usually without symptoms and becomes inactive
• reactivated by certain conditions

Question 9

What is Stage 3 of HSV?

Answer 9

Recurrence

• Reactivated by certain emotional or physical stresses
  i. e. stress, UV light, Fatigue, fever, hormones, immune depression, trauma

Question 10

Signs and symptoms of HSV

Answer 10

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

Question 11

HSV of pharynx appearance

Answer 11

in exudative or ulcerative lesions of posterior pharynx or tonsillar pillars
Difficult to distinguish from strep pharyngitis

Question 12

Possible DDX you need to R/O

Answer 12

Impetigo, so culture

Question 13

Diagnosis of HSV

Answer 13

• Usually made clinically
• Viral culture
• throat culture
• HSV 1 and HSV2 serology
• Tzanck Smear

Question 14

What do you see on a Tzanck smear for HSV?

Answer 14

Multinucleated giant cells

Question 15

How do you treat HSV?

Answer 15

oral anti-viral

- tx when first feel prodrome

Question 16

What is a good Tx of HSV for patients afraid of oral agents

Answer 16

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

Question 17

What do oral HPV infections cause

Answer 17

Genital warts, and cervical cancer

-increasingly recognized in oral infections including base of tongue and tonsils

Question 18

Epidemiology of HPV

Answer 18

Men > women
HPV16 most frequent subtype
Transmitted via sexual contact
Smoker > non-smokers

Question 19

Signs and symptoms of HPV

Answer 19

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

Question 20

Prevention of HPV

Answer 20

-Sexual abstinence (dental dams, barrier contraceptives)

Question 21

Vaccine for HPV

Answer 21

They are prophylactic and don’t treat an existing infection
CDC recommends:
Women/girls: 11-26 years old.
Men/boys: 9-26 years old

Question 22

Treatment for HPV

Answer 22

Excision and biopsy of all lesions
Tx then based on biopsy findings
Radiation and chemotherapy
patient education is important

Question 23

Complication of HPV

Answer 23

• > 50% in head/neck CA