| What are some generalities related to HSV infection? | Primary infection is first contact w/HSV1 or HSV2 could be symptomatic or asymptomatic
Initial non-primary infection is second or more exposure
Recurrence is clinical expression in a pt previously infected by same viral type (if got before HSV1 and now gets HSV2 not recurrence)
Shedding: finding HSV1 in an asymptomatic pt
Reactivation clinical recurrence or asymptomatic viral secretion. |
| How is epidemiology of HSV? | HSV is a DNA virus two types 1 and 2, very homologous, HSV1 affects upper body and HSV2 usually genitals, although HSV1 could be found in genitals, HSV2 is increasing in teens (typical genital lesions for a teen pt)
Genital herpes is 1st cause of genital ulcer disease in developed countries. |
| What are risk factors for getting HSV2 infection? | Female, early first intercourse, number of sexual partners, hx of STI, HIV +, low socioeconomic level |
| How is primary oral infection (Acute Herpetic Stomatitis)? | Usually HSV1 in small children from 6 months, when no maternal Abs, IP 3-6 days, preceded by pain, dysphagia and sialorrhea, in context of general malaise w/fever>39C
Gums swollen and bleeding, gray erosions on oral mucosa, set w/ a red border and becomes an ulcer covered with white coat. |
| How is primary genital infection? | HSV2 mainly, maybe HSV1.
Young women get acute vulvovaginitis, extreme painful and brutal febrile malaise.
Man get less intense, and confused with recurrent herpes presentation, burn urination, dysuria, anitis, anorectitis or erosions may be seen man or woman especially homos. |
| Describe the women vuvlvaginitis caused by acute genital herpes? | -Efflorescence-vesicles on the mucous membrane is swollen vulva are mostly ephemeral
-Erosions rounded contours polycyclic ulcers sometimes, also extending toward the anus
-Herpetic lesions often coexist on the vaginal walls and cervix, but the pain make gynecological examination impossible
-They often beyond the skin side, the root of the thighs, buttocks and pubic area, lymphadenopathy
-Sensitive groin are constant, frequent urine retention, exacerbation of pain by urination very painful
The spontaneous healing, request 2-3 weeks |
| What are other symptoms of primary herpetic infection? | Skin (get finger eczema that we should be careful of to not get the infection)
Opthalmo (keratoconjuctivitis, blisters on swollen eyelids cervical lymphadenopathy)
ENT (herpetic angina, acute rhinitis, nasal obstruction, perinasal vesicles, and cervical lymphadenopathy) |
| What are severe presentations of primary herpetic infection? | IC (almost always HSV1, extensive lesions necrotic and persistent, may be generalized/systemic)
Atopic (gingivatomastitis severe, kaposi's sarcoma which is generalized crusting of children skin by hemorrhagic vesicles rapid spread)
Pregnant women (increased risk of hepatitis or fulminant encephalitis)
Newborn (rare but severe in utero transmission, growth retardation, uterine, ocular, cardiac issues)
Neonatal herpes (mucucutaneous, neurological [15% MR] or systemic [60% MR]) |
| How is recurrent herpes? | Clinical presentation (80% HSV infections go latent and recur after febrile infection, UV, rules, stress, trauma, regional surgery, morphine, sex)
Seen anywhere on body, IMPORTANT decrease recurrence with age |
| Describe the clinical features of recurrent herpetic infection depending on location | herpes labialis [sore on vermilion and skin]
herpes nasal [folliculitis]
herpetic stomatitis [painful erosions]
herpetic keratitis [corneal ulcerations cause vision loss w/uveitis]
genital herpes [HSV2 but difficult dx erosion, fissure...], signs on the location of primary sx, healing needs 7-15 days for vesicles and erosion crusts. |
| Describe clinical features of recurrent herpetic infection depending on severity and skin reaction. | IC (frequent recurrence, prolonged atypical presentations, ulcers, blisters, pustules)
Systemic involvement (meningoencephalitis, esophagitis [HSV1], hepatitis [rare, pregnant and IC], pulmonary [elderly/IC]
Skin reaction (may be followed by erythema multiforme, maculopapular lesion in target blistering associated with mucosal involvement, most HSV is most common cause of recurrent erythema multiforme) |
| How is dx of HSV? | Collect fluid from vesicle then either culture virus (2-3 days), Ag search (IF, ELISA, 1-5 hrs poor sensitivity), PCR (best), Tzanck test (effects of groups, MCNs), serology (Igs 10 days after 1st test) |
| How is tx of HSV? | Topical not effective (only used before recurrence when there is a tingling sensation)
Acyclovir (PO/PRL, imp used effective and cheap), Valacyclovir (better but more costly), Foscarnet (if resistant HSV)
Normal dose: 200mg 5time/day for 10 days adults/ 5mg/kg/8h for children or valcyclovir 500 one tablet BID/10 days
If recurrence same tx but for 5 days, may get preventive tx if >6 recurrences/year 400mg 2 tablets BID/day for several months
Followup (support and QoL evaluation) |
| How is tx of neonatal HSV and pregnant women HSV? | Neuro/systemic neonatal (acyclovir IV 60mg/kg/day for 21 days)
for mucocutaneous same for 14 days
Pregnant (<1 months predelivery same as normal but continue till delivery, if before last month give it normally for 10 days)
Cesarian section done if there are lesions during labor or if no lesions but primary infection since <1 month and untreated.
Vaginal delivery in case of no lesions w/primary infection since >1 month/ recurrence since more than 7 days |
