Herpes Simplex Virus

Question 1

What are the seroprevalence rates of HSV-1 and HSV-2 among persons aged 14 to 49 years in the United States?

Answer 1

HSV-1: 47.8%, HSV-2: 11.9%

These rates indicate the prevalence of these viruses in a significant age group.

Question 2

What is the primary cause of recurrent genital herpes?

Answer 2

HSV-2

Although HSV-1 is increasingly causing first-episode genital herpes.

Question 3

What percentage of first-episode genital herpes is caused by HSV-1 in certain populations?

Answer 3

Up to 70%

Particularly noted in young adult women and men who have sex with men.

Question 4

What is the relationship between HSV-2 infection and HIV acquisition risk?

Answer 4

Increases the risk two- to three-fold

This is due to the immunocompromised state associated with HSV-2.

Question 5

What are the classic manifestations of oral HSV-1 infection?

Answer 5

Sensory prodrome, lesions on lips and oral mucosa evolving from papule to vesicle, ulcer, and crust

The course of illness lasts 5 to 10 days.

Question 6

What are the typical local symptoms associated with genital herpes?

Answer 6

Sensory prodrome, pain, pruritus, dysuria, and vaginal or urethral discharge

Inguinal lymphadenopathy is also common, especially in primary infection.

Question 7

True or False: Genital HSV-1 infections typically have more recurrences than genital HSV-2 infections.

Answer 7

False

Recurrences and viral shedding occur less often with genital HSV-1 infections.

Question 8

What is the preferred laboratory method for diagnosing mucocutaneous HSV infections?

Answer 8

HSV DNA polymerase chain reaction (PCR)

PCR is the most sensitive method for diagnosis.

Question 9

What should be considered when counseling a patient diagnosed with HSV-2?

Answer 9

Risk of transmitting infection to sex partners

Counseling guidelines are provided in CDC STD Treatment Guidelines.

Question 10

Fill in the blank: Consistent use of _______ reduces HSV-2 acquisition among heterosexual couples.

Answer 10

latex condoms

This is important for preventing transmission of HSV-2 and other STIs.

Question 11

What antiviral therapy can reduce HSV-2 transmission to susceptible partners by 48%?

Answer 11

Suppressive antiviral therapy (e.g., valacyclovir 500 mg once daily)

This applies to HSV-2 seropositive persons with symptomatic genital herpes.

Question 12

What is the recommended treatment duration for first episodes of genital HSV?

Answer 12

7 days to 10 days

Recurrences can be treated for 5 to 10 days.

Question 13

What is the treatment of choice for acyclovir-resistant HSV?

Answer 13

IV foscarnet

IV cidofovir is a potential alternative.

Question 14

What is the effect of suppressive therapy with antiviral drugs on HIV progression?

Answer 14

Does not delay HIV progression

Antiviral regimens for herpes should not replace ART.

Question 15

What is the risk associated with HSV acquisition late in pregnancy?

Answer 15

Higher risk of neonatal HSV transmission

This is particularly a concern for HSV-2-seropositive pregnant women.

Question 16

True or False: Acyclovir is considered safe for use during pregnancy, especially in the second and third trimesters.

Answer 16

True

It has the most reported experience in pregnancy.

Question 17

What should be monitored in patients receiving high-dose IV acyclovir?

Answer 17

Renal function

Monitoring should be done at initiation and once or twice weekly during treatment.

Question 18

What is the primary concern with HSV during pregnancy?

Answer 18

Potential for transmission to the fetus or neonate

This can have serious consequences, including fatal outcomes.

Question 19

What does suppressive therapy with oral acyclovir, valacyclovir, or famciclovir effectively prevent?

Answer 19

Recurrences of HSV lesions

It is particularly preferred for patients with severe or frequent recurrences.

Question 20

What antiviral drugs are mentioned as safe and well tolerated during pregnancy?

Answer 20

Valacyclovir and famciclovir

These drugs are particularly noted for their use in the third trimester.

Question 21

What is the predominant risk factor for neonatal HSV transmission during delivery?

Answer 21

Maternal genital shedding of HSV at delivery

This is a critical factor in the potential transmission of HSV to the neonate.

Question 22

When is cesarean delivery recommended for women with genital herpes?

Answer 22

When there is a genital herpes prodrome or visible HSV genital lesions at the onset of labor

This recommendation aims to reduce the risk of neonatal HSV transmission.

Question 23

What is the recommended suppressive therapy for pregnant women with recurrences of genital herpes?

Answer 23

Suppressive therapy with either valacyclovir or acyclovir starting at 36 weeks’ gestation

This is recommended for managing recurrences during pregnancy.

Question 24

What is the dosing regimen for treating orolabial lesions?

Answer 24

Valacyclovir 1 g PO twice a day, Famciclovir 500 mg PO twice a day, or Acyclovir 400 mg PO three times a day

Duration of treatment is 5–10 days.

Question 25

What is the treatment duration for initial genital lesions?

Answer 25

7–10 Days ## Footnote This is the recommended duration for initial genital lesions.

Question 26

What constitutes chronic suppressive therapy for HSV?

Answer 26

Valacyclovir 500 mg PO twice a day, Famciclovir 500 mg PO twice a day, or Acyclovir 400 mg PO twice a day ## Footnote This is for patients with severe recurrences or those who wish to minimize recurrence frequency.

Question 27

What is the preferred therapy for acyclovir-resistant mucocutaneous HSV infections?

Answer 27

IV Foscarnet 80–120 mg/kg/day in 2–3 divided doses until clinical response ## Footnote This therapy is recommended for managing resistant infections.

Question 28

Fill in the blank: Suppressive therapy is not recommended for women who are seropositive for HSV-2 but have _______.

Answer 28

no history of genital lesions

Question 29

True or False: Neonatal HSV disease has been reported in infants born to women treated with antenatal suppressive antiviral therapy.

Answer 29

True ## Footnote This indicates that while therapy is beneficial, it may not eliminate all risks.

Question 30

What is the treatment for severe mucocutaneous HSV infections?

Answer 30

Acyclovir 5 mg/kg IV every 8 hours, then switch to oral therapy as lesions regress ## Footnote Continue treatment until lesions have completely healed.

Question 31

How often should the need for suppressive therapy be evaluated?

Answer 31

Annually ## Footnote Regular evaluation helps determine ongoing necessity.

Question 32

What is the alternative therapy for acyclovir-resistant mucocutaneous HSV infections?

Answer 32

IV cidofovir 5 mg/kg once weekly or topical formulations ## Footnote Topical formulations include trifluridine, cidofovir, imiquimod, and foscarnet.