Herpes Virus Infections

Question 1

What are the different types of herpes simplex viruses?

Answer 1

HSV 1 - Cold sores (although now most common cause of genital herpes in UK)
HSV 2 -Genital herpes
There is considerable overlap between the symptoms of herpes.
Recurrent infections can lead to infections elsewhere eg, neurological

Question 2

What are the symptoms of herpes infections?

Answer 2

• Oral ulcers,
• Genital Ulcers
• Lymphadenopathy,
• Dysuria in women
• Tingling sensation which is part of prodrome (occurs before lesion)
• Fever and malaise which typically is only present in the first episode. First episode is normally the worst.
• Risk factors for symptoms = immunosupression, HIV

Question 3

What are the differential diagnosis for herpes infections?

Answer 3

Syphilis,
Chancroid,
Lymphogranuloma venereum (painless genital ulcer followed by painful inguinal lymphadenopathy)

Question 4

What are the investigations for HSV?

Answer 4

When lesions are present you can do: HSV PCR and NAAT from swabs

Question 5

What is the treatment for the first episode of HSV?

Answer 5

Treatment with first episode is the most critial and should be provided to patients as it reduces risk of neurological complications.
Give Oral Aciclovir for 7-10 days
For recurrent episodes give Aciclovir for 5 days.
Dosages are different for first/recurrent episode, genital or oral.

Question 6

What is the management of HSV in pregnancy?

Answer 6

• Referral to GUM clinic and immediate treatment (400mg aciclovir TDS for 5 days)
• Low risk of transmitting to neonate.

Question 7

What are the features of herpes simplex encephalitis?

Answer 7

Fever,
Headaches,
Psychiatric symptoms
Seizures
Vomiting
Focal features eg, aphasia
- Peripheral lesions have NO relation to HSV encephalitis

Question 8

Where is HSV encephalitis most likely to affect?

Answer 8

Temporal and inferior frontal lobes

Question 9

What are the investigations for suspected herpes encephalitis?

Answer 9

• Lumbar puncture - lymphocytosis and elevated protein, PCR for HSV,
• Bloods and blood cultures
• CT/MRI: medial temporal and inferior frontal lobe changes
• EEG changes

Question 10

What is the treatment for HSV encephalitis?

Answer 10

IV Aciclovir
However if unsure about bacterial cause then also give 2mg IV ceftriaxone BD

Question 11

What are the differentials for encephalitis?

Answer 11

Hypoglycaemia,
Hepatic encephaopathy
DKA
Drug induced encephalopathy
Uraemic encephalopathy

Question 12

What are some other causes of encephalitis?

Answer 12

Cytomegalovirus,
EBV,
VZV,
HIV

Question 13

Describe features of herpes simplex keratitis

Answer 13

HSV infection of the cornea which presents with:
- Red painful eye,
- Photophobia,
- Epiphora (excess tears/watery eyes)
- Reduced visual acuity