Viral Infections: HERPES SIMPLEX

Question 1

HERPES SIMPLEX

Clinical Feature

Answer 1

herpetiform (i.e. grouped) vesicles on an erythematous base on skin or mucous membranes

Question 2

HERPES SIMPLEX transmition

Answer 2

via contact with erupted vesicles or via asymptomatic viral shedding

Question 3

HERPES SIMPLEX primary. Popuation affected. other symptomps and Course

Answer 3

followed by antibody formation and latency of virus in dorsal nerve root ganglion

Question 4

HERPES SIMPLEX secondary. Population. Prodrome. Triggers

Answer 4

recurrent form seen in adults; much more common than primary
prodrome: tingling, pruritus, pain
triggers for recurrence: fever, excess sun exposure, physical trauma, menstruation, emotional stress,
URTI

Question 5

HERPES SIMPLEX

complications:

Answer 5

dendritic corneal ulcer, EM, herpes simplex encephalitis (infants at risk), HSV infection
on AD causing Kaposi’s varicelliform eruption (eczema herpeticum

Question 6

HSV-1. Locations

Answer 6

typically “cold sores” (grouped vesicles at the mucocutaneous junction which quickly burst)
recurrent on face, lips, and hard palate, but NOT on soft, non-keratinized mucous membranes
(unlike aphthous ulcers)

Question 7

HSV-2 transmittion . Incubation. And common concomitant inflamations

Answer 7

usually sexually transmitted; incubation 2-20 d.

gingivostomatitis:, vulvovaginitis:,urethritis:.

Question 8

HSV-2 gingivostomatitis:

Answer 8

entire buccal mucosa involved with erythema and edema of gingiva

Question 9

HSV-2

vulvovaginitis:

Answer 9

edematous, erythematous, extremely tender, profuse vaginal discharge

Question 10

HSV-2 urethritis:

Answer 10

watery discharge in males

Question 11

HSV-2 differential diagnosis of genital ulcers

Answer 11

Candida balanitis, chancroid, syphilitic chancres

Question 12

HSV-2

Investigations.Locals, blood test?

Answer 12

Tzanck smear with Giemsa stain shows multinucleated giant epithelial cells
• viral culture, electron microscopy, and direct fluorescence antibody test of specimen taken from the
base of a relatively new lesion
• serologic testing for antibody for current or past infection if necessary

Question 13

HSV-1 Management

Answer 13

treat during prodrome to prevent vesicle formation
 topical antiviral (Zovirax®/Xerese®) cream, apply 5-6x/d x 4-7 d for facial/genital lesions
 oral antivirals (e.g. acyclovir, famciclovir, valacyclovir) are far more effective and have an easier
dosing schedule than topicals

Question 14

HSV-2 Management First measures

Answer 14

rupture vesicle with sterile needle if you wish to culture it
wet dressing with aluminum subacetate solution, Burow’s compression, or betadine solution

Question 15

HSV-2 oral management

Answer 15

1st episode: acyclovir 200 mg PO 5x/d x 10 d
maintenance: acyclovir 400 mg PO bid
famciclovir and valacyclovir may be substituted and have better enteric absorption and less frequent
dosing

Question 16

HSV-2 additional management

Answer 16

in case of herpes genitalis, look for and treat any other STIs
for active lesions in pregnancy, see Obstetrics, OB29