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DipGUM 🤦‍♀️ > HSV > Flashcards

HSV Flashcards

1
Q

Describe non primary HSV infection

A

First infection with HSV 1 or 2 in an individual with pre existing antibodies to the other type

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2
Q

HSV - 1 aetiology

A

Historically usual cause of oral but now commonest cause of genital in Uk

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3
Q

HSV 2 aetiology

A

More likely to cause recurrent anogential Sx

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4
Q

Average number of HSV recurrences per year

A

4 for HSV 2

4 x less frequent for HSV 1

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5
Q

HSV symptoms

A

Lesions
Vaginal or urethral discharge
Systemic symptoms common with Primary

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6
Q

HSV signs

A

Ulcers on external genitalia or rectum/ cervix
Bilateral lymphadenitis
First episode - usually bilat
Recurrent disease - lesions affect favoured sites. Can alternate but usually unilateral for each episode
Lymphadenitis 30%
Recurrent outbreaks limited to infected dermatome
Many can present atypically - fissures, non specific erythema

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7
Q

HSV complications

A

Superinfection of lesions with Candida or streptococcal species (usually 2nd week)
Autonomic neuropathy (urinary retention)
Autoinnoculation to fingers and adjacent skin
Aseptic meningitis

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8
Q

Herpes proctitis

A
  • Significant cause of proctitis in MSM
  • Only 30% of MSM with HSV proctitis had visible external anal ulceration
  • more common with HIV
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9
Q

Tests for HSV?

A

-Do viral PCR NAAT
Swab base of lesion or rectal mucosa
All MSM with proctitis - HSV swab
- serology
IgG type 1 or 2
HSV 2 genital but HSV1 can’t tell if oral or genital
Western blot is diagnostic gold standard
For patients with low likelihood HSV but positive HSV2 serology - repeat test

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10
Q

When is serology helpful for HSV?

A

Recurrent genital disease of unknown cause
Counselling patients with initial episode (pregnant women)
IX asymp partners of patients with HSV inc pregnancy

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11
Q

HSV first episode general advice

A

Saline baths
Analgesia
Topical lidocaine (potential for sensitisation but Low risk)

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12
Q

HSV when to start antivirals

A

Within 5/7 of start of episode
While new lesions are still forming
Systemic Sx persist

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13
Q

HSV usual regimes primary episode

A

Aciclovir 400mg TDS 5/7
Valaciclovir 500mg BD 5/7

Reduction is median 1-2 days of Sx

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14
Q

HSV alternative regimes for primary episodes

A

Aciclovir 200mg five times daily

Famciclovir 250mg TDS

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15
Q

Recurrent HSV episode - short course options

A

Aciclovir 800mg TDS for 2/7
Famciclovir 1g BD for 1 day
Valaciclovir 500mg BD for 3/7

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16
Q

Recurrent episodic HSV regimes 5 day

A

Aciclovir 200mg fives times daily
Aciclovir 400mg rfs for 3-5 days
Valaciclovir 500mg bd
Famciclovir 125mg bd

17
Q

Suppressive antiviral therapy

A 
6 recurrences per year
Aciclovir 400mg BD
Aciclovir 200mg four times daily 
Famciclovir 250mg BD
Valaciclovir 500mg OD

Stop after one year max to reassess for recurrences
Minimum of two recurrences as often rebound flare on stopping

18
Q

When to use empirical HSV RX?

A

MSM with proctitis as such a common cause

19
Q

Asymp shedding - when most likely and how does it change

A

Most common in those with HSV 2 in first year after infection and in those with frequent recurrences
Cause of transmission
Reduced by antivirals
For many patients it declines with time

20
Q

How to prevent transmission HSV

A

Condoms - approx 50% reduction at least 60% of the time.
Drugs reduce asymp shedding by 90%
Study only on valaciclovir showed decreased acquisition in serodiscordant couples

21
Q

What to tell patient about HSV transmission?

A

No sex when lesions or prodromes
Asymp shedding
Male condoms may reduce risk of transmission
Suppressive antivirals reducing risk of transmission if sero discordant
Disclose in all relationships
Can contact HSV association for support
Document the discussion

22
Q

HSV positive partners and strategies if their partner is pregnant

A

Condom use particularly last trimester
No sex when lesions or in last 6 weeks of pregnancy
Tell Midwife

23
Q

HSV and hiv
Key points
What to do with dose?

A 
HSV increases hiv acquisition
Anti viral resistance more common
Double dose if advanced HIV
10/7
More frequent reactivation 
Optimise ART
24
Q

Three subgroups of neonatal HSV

A

1) localised to skin, eyes and or mouth 30%
2) local CNS disease (encephalitis) 70%. Often present late (10/7-4/52).
3 disseminated with multi organ - 30% mortality

25
Q

Transmission risk factors for neonatal HSV

A 
Primary
Duration of ROM prior to del
Use of FSE
Mode of del
New infection in third trimester but particularly in 6 weeks prior to del (no time for maternal antibodies)
26
Q

Primary episode prior to 28/40 Mx

A 
GUM
Usual regime
Cons led care for obs 
No change to plan unless del within next 6/52
Give aciclovir 400mg tds from 26/40
27
Q

Recurrent HSV in pregnancy mx

A

Low risk
Vag del
Consider suppression from 36/40 - 400mg tds women’s choice
No increased risk pprom or preterm del

28
Q

New HSV in third trimester

A

Aciclovir 400mg tds until del
Section
IgG to check incase recurrent

29
Q

Primary HSV lesions at labour Mx

A

Section
Can use iv acickovir for mother ans baby (defo if vag del happens)
Avoid FSE, instruments etc

30
Q

Pprom before 37/40 and primary lesions Mx

A

Section if del straight away

If conservative Mx - consider iv aciclovir

31
Q

Pprom before 37/40 and recurrent lesions Mx

A

Before 34/40 - expectant ok with oral aciclovir 400 tds

After 34/40 - obs decision/ ? Steroids also

32
Q

Hiv and HSV in pregnancy transmission and drugs

A

More likely to transmit hiv if concurrent HSV in pregnancy

Aciclovir from 32/40 as hiv more at risk of preterm del

33
Q

Neonate born by section following primary infection in 3rd trimester Mx

A

Low risk
No additional
Report lesions/ poor feeding
Good hand hygiene

34
Q

Vaginal del following primary episode in later 6 weeks. Mx of neonate

A

If well - swab skin, eyes, rectum, throat. No LP. Aciclovir 20mg/kg until excluded active infection

35
Q

Vag delivery post maternal primary HSV within 6 weeks del and baby unwell

A

Swab everywhere and aciclovir until cultures back

LP also

36
Q

Neonatal IV dose of aciclovir

A

20mg/kg tds

37
Q

Neonatal Mx following delivery and maternal recurrent episode in pregnancy (with or without lesions at del)

A

Nil different

Says inform neonataologisy

DipGUM 🤦‍♀️ (29 decks)

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