Herpes simplex virus

Question 1

Herpes simple virus (HSV) an be grouped into HSV-1 and HSV-2. Although there is a lot of overlap, typically which of these infects the genitals?

Answer 1

• HSV-2
• HSV-1 infects above the waist (mouth and tongue), but there is a lot of overlap between the 2

Question 2

Which of the following is the most common cause of genital ulceration worldwide?

1 - chlamydia
2 - HSV-1 and 2
3 - gonorrhoea
4 - syphilis

Answer 2

2 - HSV-1 and 2

Question 3

HSV is a member of the herpes virus family. Which of the following is NOT part of the herpes family virus?

1 - HSV1 and 2
2 - Human immunodeficiency virus
3 - Cytomegalovirus
4 - Varicella Zoster Virus
5 - Ebstein Barr Virus
6 - Human Herpes Virus-8

Answer 3

2 - Human immunodeficiency virus

• HSV1 and 2 = oral-genital ulceration
• Cytomegalovirus = hepatitis, retinitis, encephalitis, enteritis
• Varicella Zoster Virus = Chicken pox, shingles
• Ebstein Barr Virus = Glandular Fever
• Human Herpes Virus-8 = Kaposi Sarcoma

Question 4

Which of the following does HSV-1 and 2 contain?

1 - enveloped double stranded DNA virus
2 - enveloped single stranded DNA virus
3 - non-enveloped double stranded RNA virus
4 - non-enveloped single stranded DNA virus

Answer 4

1 - enveloped double stranded DNA virus

Question 5

How is HSV typically transmitted?

1 - air droplets
2 - contaminated food
3 - contact with the virus in sores, saliva or surfaces in or around the mouth
4 - contaminated water

Answer 5

3 - contact with the virus in sores, saliva or surfaces in or around the mouth

Question 6

When infected patients can present immediately with symptoms. Which of the following is typically NOT an immediate sign of infection?

1 - severe gingivostomatitis (infected mouth)
2 - cold sores
3 - infection of trigeminal and sacral ganglion
4 - painful genital ulceration

Answer 6

3 - infection of trigeminal and sacral ganglion

• forms part of latent infection
• trigeminal ganglion is for the face
• sacral ganglion is for the genitailia

Question 7

Are the genital ulcers present in HSV infection painful of painless?

Answer 7

• Painful

Painful = HSV and Chancroid
Painless = Syphilis and lymphogranuloma venereum

Question 8

If a patient is infected with HSV-1 or 2, this can cause fever and enlarged lymph nodes. This can also cause lesions in which of the following?

1 - palate
2 - tongue
3 - lips
4 - gums
5 - facial area
6 - all of the above

Answer 8

6 - all of the above
- lesions present as clusters of small, painful and fluid filled blisters
- blisters typically heal over a few weeks

Question 9

If the female genitals are infected, which of the following do the lesions NOT typically form?

1 - labia minor and majora
2 - mons pubis
3 - vaginal mucosa
4 - cervix
5 - clitoris

Answer 9

5 - clitoris

• can also form in the perianal region

Question 10

If the male genitals are infected, where do the lesions typically form?

1 - epididymis
2 - scrotum
3 - prostate
4 - shaft of the penis

Answer 10

4 - shaft of the penis

• can also form in the perianal region
• these are painful lesions

Question 11

If the finger becomes infected this can cause what?

1 - koilonychia
2 - clubbing
3 - leukonychia
4 - herpetic whitlow

Answer 11

4 - herpetic whitlow
- recurrent painful HSV on fingers
- can easily be spread to other areas

Question 12

If the eye becomes infected this can cause what?

1 - conjunctivitis
2 - dendritic ulcer of the eye
3 - blepharitis
4 - uveitis

Answer 12

2 - dendritic ulcer of the eye
- if untreated it can cause scarring of the cornea

Question 13

If the brain becomes infected this can cause what?

1 - meningitis
2 - hydrocephalus
3 - encephalitis
4 - all of the above

Answer 13

4 - all of the above
- typically caused by HSV-1

Symptoms:
- Fever (90%)
- Headache (81%)
- Psychiatric symptoms (71%)
- Seizures (67%)

Question 14

If a patient has suspected meningitis or encephalitis, all of the following are common presentations, EXCEPT which one?

1 - Fever
2 - Headache
3 - Epistaxis
4 - Psychiatric symptoms
5 - Seizures

Answer 14

3 - Epistaxis

Question 15

HSV can cause both meningitis and encephalitis, but which is more commonly due to HSV infection?

Answer 15

• meningitis

BUT encephalitis is typically more severe with a mortality of 70%

Question 16

What is typically the gold standard for diagnosing a patient with suspected HSV?

1 - viral swab with PCR
2 - urinalysis
3 - blood sample
4 - any of the above

Answer 16

1 - viral swab with PCR

• antibody testing can be performed, but no longer routinely

Question 17

Not all patients require medication if infected with HSV, with a large proportion remaining asymptomatic. What proportion of patients actually develop symptoms?

1 - 3%
2 - 13%
3 - 33%
4 - 66%

Answer 17

3 - 33%

Question 18

Is HSV-1 or HSV-2 more likely to re-occur?

Answer 18

• HSV-2 is more likley to re-occur
• HSV-1 has a recurrences rate of 0.34/month

Question 19

What is the 1st line management for a patient with HSV?

1 - aciclovir
2 - ceftriaxone
3 - doxycycline
4 - fluconazole

Answer 19

1 - aciclovir
- nucleotide analogue antiviral
- 400mg 3/day (TDS) for 5 days

• Lidocaine gel for lesion relief
• Salt bathing for gingivostomatitis
• Abstinence to avoid spreading

Question 20

If a patient has HSV encephalitis, which 2 of the following would be used to treat the patient?

1 - aciclovir
2 - ceftriaxone
3 - valaciclovir
4 - fluconazole

Answer 20

1 - aciclovir
- given via IV

3 - valaciclovir
- given orally

Total of 21 days

Patients may also need management for seizures