Infectious Disease/ HSV

Question 1

What are the signs and symptoms of primary genital herpes simplex virus (HSV) infection?

Answer 1

• multiple
• shallow
• tender ulcers that may be vesicular
• fever
• headache
• dysuria
• tender lymphadenopathy

Question 2

What is the mean duration of lesions in patients with primary genital HSV?

Answer 2

19 days

Question 3

What is the mean duration of lesions in patients with nonprimary genital HSV lesions?

Answer 3

10 days

Question 4

What percentage of patients with primary HSV will develop aseptic meningitis?

Answer 4

8%

Question 5

The majority of patients with HSV-2 primary infection will experience recurrence. True or false?

Answer 5

True

Question 6

What is the median number of HSV-2 recurrences per year?

Answer 6

4

Question 7

What is the median number of HSV-1 recurrences per year?

Answer 7

1

Question 8

What other conditions can present with genital ulcers besides HSV?

Answer 8

• Primary syphilis
  
  • typically painless
  • chancroid (deep, purulent ulcer with painful, inguinal lymphadenopathy)

Question 9

What tests can be used to confirm a diagnosis of genital HSV?

Answer 9

• testing of vesicular fluid can include viral culture
• Tzanck smear (though this cannot distinguish between HSV-1 and HSV-2)
• polymerase chain reaction (particularly useful for asymptomatic HSV shedding) and
• direct fluorescent antibody testing

Question 10

When do HSV antibodies form?

Answer 10

Several weeks after infection and persist indefinitely

Question 11

What are the benefits of treating patients with primary HSV with oral antiviral agents?

Answer 11

• decreased duration and severity of the infection by days to weeks
• decreased risk of complicated primary HSV infection

Question 12

Which antiviral agents are typically used?

Answer 12

• Either acyclovir 400 mg PO three times daily,
• Famciclovir 250 mg PO three times daily, or
• Valacyclovir 1000 mg PO twice daily
  
  • for 7-10 days

Question 13

What is complicated HSV?

Answer 13

• Primary HSV infection with aseptic meningitis
• encephalitis
• transverse myelitis
• hepatitis
• pneumonitis or
• disseminated HSV

Question 14

What other treatments can be offered to patients with dysuria secondary to ulcerations?

Answer 14

• Analgesics
• Sitz baths

Question 15

What are the treatment options for patients with recurrent genital HSV?

Answer 15

• Chronic suppressive therapy
• episodic therapy or
• watchful waiting can be initiated depending on the frequency of episodes
• Patients with six or more episodes per year are frequently on chronic suppressive therapy.

Question 16

What regimens can be used for chronic suppressive therapy?

Answer 16

• Acyclovir 400 mg PO twice daily
• Famciclovir 250 mg PO twice daily
• Valacyclovir 500 mg PO once daily

Question 17

What regimens can be used for episodic therapy?

Answer 17

• Acyclovir 800 mg PO three times daily for 2 days
• Famciclovir 1000 mg PO twice daily for 1 day
• Valacyclovir 500 mg PO twice daily for 3 days