HSV

Question 1

Define Initial Episode in HSV

Answer 1

First episode of either HSV I or 2

Question 2

Define primary infection in HSV

Answer 2

Infection with no pre-existing antibodies to the other type

Question 3

Define non-primary infection in HSV

Answer 3

Infection with pre-existing antibodies to the other type

Question 4

Define recurrent episode in HSV

Answer 4

Symptoms due to reactivation of pre-existing HSV 1/2 after period of latency

Question 5

Incubation period of HSV

Answer 5

2 days - 2 weeks (1/3 develops symptoms at time of acquisition)
Can be up to years

Question 6

Which HSV type has a higher recurrence rate?

Answer 6

HSV 2 (0.34 per month / 4 x per year)

Question 7

Symptoms seen typically during primary episode of HSV only

Answer 7

Bilateral lymphadenopathy
Systemic symptoms
Lesions are non-dermatomal

Question 8

Diagnosis of HSV

Answer 8

via PCR

Question 9

When is HSV serology useful (IgG only)

Answer 9

During pregnancy to determine if new infection
Rule out HSV in PCR negative ulcers
In sero-disconcordant couples

Question 10

Management of HSV acute episode 1st line

Answer 10

Aciclovir 400mg TDS for 5 days
(review after 5 days and consider longer course if indicated (7-10))

Question 11

When to prescribe HSV antivirals in acute episode

Answer 11

Within 5 days
While new lesions are forming
Persistent systemic symptoms

Question 12

Management of HSV acute episode (3 x alternative options)

Answer 12

Valacyclovir 500mg BD
Famciclovir 250mg TDS
Aciclovir 200mg 5 x per day

Question 13

Management of recurrent HSV (episodic treatment)

Answer 13

Aciclovir 800mg TDS (2 days)
Valaciclovir 500mg BD (3 days)
Famaciclovir 1g BD (1 day)

Aim to initiate early (pre-papules)

Question 14

When to consider HSV suppression

Answer 14

> 6 recurrence per year
Painful recurrences
Not controlled with episodic therapy
Complications inc. psychological

Question 15

Management of recurrent HSV (suppression)

Answer 15

Aciclovir 400mg BD
Valaciclovir 500mg OD
Famciclovir 250mg BD

May require dose reduction in renal disease

Question 16

When should you review HSV suppression

Answer 16

After 1 year to reassess recurrence rate - if unacceptable, continue

Question 17

Management of acute episode of HSV in advanced HIV

Answer 17

Aciclovir 400mg 5x daily
Valaciclovir 1g BD
Famciclovir 500mg TDS

For 10 days (or until all lesions healed)

In severe disease - IV aciclovir 5-10mg/kg TDS

Question 18

Who is at risk of drug resistant HSV?

Answer 18

Immunocompromised (not only in HIV)

Question 19

Mutation of which gene causes HSV resistance?

Answer 19

HSV TK

Question 20

What treatment is available in TK deficient HSV strains?

Answer 20

Foscarnet
Cidofovir