Infection Flashcards
Most common HSV causing infection
HSV-1 90%
HSV-2 rare often assoc with oro-genital sex
Transmission of HSV-1
via direct contact with infected secretions entering via the skin or mucous membranes, from a person who is actively shedding the virus.
The virus can be transmitted by salivary transfer by kissing or sharing utensils or towels, if there is contact with mucus membranes or open or abraded skin
A person sheds HSV-1 for a median duration of 4–60 hours after the onset of symptoms , and HSV can be transmitted from oral mucosa or skin surfaces that appear normal when no clinical lesions are present
Lesions are most contagious at the time of vesicular rupture, and continue to be contagious until they have scabbed
How long does primary oral herpes take to resolve
Primary herpes labialis lesions usually resolve within 10–14 days; gingivostomatitis usually resolves within 2–3 weeks.
Describe key sequalae with oral HSV
Herpes labialis may present with a prodrome of fever, sore throat, and lymphadenopathy, particularly in primary infections.
Initial symptoms of pain, burning, tingling, and itching may precede visible lesions and typically last 6–48 hours.
Herpes labialis lesions are typically crops of vesicles that rupture, ulcer, crust, and heal (usually without scarring).
Herpes gingivostomatitis lesions are typically crops of painful vesicles that rupture and form ulcers on the pharyngeal and oral mucosa.
People who are immunocompromised may have severe, atypical lesions anywhere in the oral cavity.
Oral HSV - Primary vs Recurrent
Primaryfirst-time exposure to HSV-1 or HSV-2 in a previously HSV seronegative person and typically occurs in children under 5 years of age in the case of HSV-1
Most HSV-1 infections are subclinical and asymptomatic, and therefore do not present to a healthcare professional
Symptomatic primary infection usually presents as gingivostomatitis in children, and is often associated with a pharyngitis in young adults
Following a primary infection, HSV-1 migrates to the local sensory ganglia (typically the trigeminal nerve ganglion), where it can remain latent indefinitely, or reactivate to cause clinical infection or asymptomatic viral shedding
Recurrent infection refers to clinically evident herpes simplex lesions in a person with usually previous HSV-1 infection — recurrent infections are more frequent in the 6 months following a primary infection
About 90% of recurrent HSV-1 infections cause herpes labialis. Recurrent gingivostomatitis is more rare, and usually occurs in people who are immunocompromised
When does oral HSV need admission
Is unable to swallow due to pain and is at risk of dehydration (especially in children).
Is immunocompromised with severe oral herpes simplex infection — they may need intravenous antiviral drug treatment.
Has a suspected serious complication of oral herpes simplex infection — they may need intravenous antiviral drug treatment.
Advice for pregnant lady with oral HSV
advise the woman that the risk of infecting the neonate by kissing is greatest when a new oral herpes infection is acquired in the third trimester, particularly within 6 weeks of delivery, as protective maternal IgG antibodies will not have had time to develop and cross the placenta and viral shedding may persist in the saliva.
Management of Oral HSV
- parac // ibuprofen
- Topical stuff OTC if helps
- Oral antivirals for epsode of pri oral HSV; recurrent infection or persistent and reccurrent gingivo
Aciclovir 5 day course longer if new leisons during treatment or incomplete healing
200mg qds or 100ms qqds <2 yrs . double dose in immunocomp
Valaciclovir - 500mg or 1g immunocomp
HSV Self Care Advice
Hydration
Pain relief
Topic inc lip barrier mouthwash OTC
Minimise trandmission - kissing, oral secx, sharing utensils etc, avoid touching and wash hands after
Care with contact lenses
Avoid triggers eg sunlight stress lack of sleep fever
Aciclovir/Valaciclovir cautions
elderly
breastfeeding caution
eGFR<10 reduce dose
