Herpes Virus lam

Which herpes stereotype is primarily asymptomatic (people are unaware of the infection)

HSV-2

Which HSV stereotype has occasional outbreaks (recrudescence) ?

HSV-1

Which HSV serotype is most commonly acquired by children?

HSV-1

Which HSV serotype has an increased risk of HIV infection?

HSV-2

HSV transmission

through close contact with a person who is shedding virus at the mucosal, epithelial, genital or oral secretions

• sex

• perinatal transmission

HSV-1 risk factors

Injury and chapped lips, stress, illness, UV, fatigue

HSV-2 is usually spread from men to women or from women to men?

men to women

How can pts tell if an ulceration is going to occur in HSV?

will begin to experience flu-like symptoms and mild tingling up to 48 hours before

T/F: HSV outbreaks becomes worse over time

false - virus becomes dormant and outbreaks typically decrease

In which type of HSV infection can oropharyngeal disease/ herpes labialis manifest?

HSV-1

In which type of HSV infection can Keratoconjunctivitis occur?

HSV-1

In which HSV type can a pt develop blindness?

HSV-1 d/t keratoconjunctivitis

In which type of HSV infection can encephalitis occur?

HSV-1

In which type of HSV infection can genital herpes occur?

HSV-2

Genital herpes sx

• small blisters that break open and cause painful sores

• Pain during urination

• Pain around genitals

• Itching

• Fatigue

Name the herpes strand responsible for varicella and zoster?

HHV-3

vaccines available for varicella

Varivax and ProQuad

vaccines available for zoster

zostavax and shingrix

cytomegalovirus is related to what herpes strand

HHV-5

What populations are usually infected by CMV/HHV-5 by the age of 40 ?

majority

CMV manifestation (what does it result in?)

• general population → asymptomatic, mild disease

• immunocompromised → systemic diseease (ie pneumonia)

• birth → developmental defects

Explain how acyclovir + analogues are used to tx HSV ?

They are activated by thymidine kinase fro HSV cell and then phosphorylated twice → damages DNA

acyclovir brand name

zovirax

Valacyclovir brand name

Valtrex

Famciclovir brand name

famvir

Which acyclic analogue has the greatest bioavailability

famciclovir

Which acyclic analogue is available in IV ?

acyclovir

What type of herpes infection are topical antivirals used for?

HSV-1 (for cold sores)

Name the two topical antivirals used for HSV-1

Docosanol (abreva) and acyclovir (Zovirax)

name the only topical antiviral available OTC

docosanol (abreva)

Directions for topical antivirals

Use 5x / day until lesions have healed

Which topical antiviral has a higher concentration?

Docosanol (abreva) ; 10%

second-line tx for HSV-1 + choices

systemic antiviral tx ; valacyclovir (q12 h for 1 day) and famciclovir (x1 dose)

When should antiviral therapy be used for first episode of genital herpes

If sx < 7 days

Acyclovir (zovirax) dosing for first episode

400 mg po tid for 7-10d

Acyclovir (zovirax) dosing for recurrent episodes/episodic therapy

400 mg po tid for 5 days (same dosing as first episode but diff duration)

Acyclovir (zovirax) dosing for chronic suppresive therapy

400 mg po bid (same dosing diff frequency)

valacyclovir (valtrex) dosing for first episode

1 g po bid for 7-10d

valacyclovir (valtrex) dosing for recurrent episode/episodic therapy

500 mg po bid for 3 days (half dose of first episode and shorter duration)

valacyclovir (valtrex) dosing for chronic suppressive therapy

500 mg po qd (half of dose and frequency of first episode)

purpose of recurrent therapy

to shorten duration of lesions

Tx duration for first episode of genital herpes

7-10 days (can be extended up to 14 days if healing is incomplete after 10 days)

Which antiviral has lower frequency of admin for tx of genital herpes? What is the frequency

Valacyclovir (valtrex); bid

Which individuals are eligible for suppressive tx of genital herpes?

If they are having > 6 recurrences per year

max duration pt can be on suppressive tx

1 year (has to be reassessed after)

Name the only antiviral that can be used for herpes that can also be admin IV

Acyclovir

Which agent for CMV cannot be used for CMV retinitis

Foscarnet (foscavir)

Ganciclovir brand name

cytovene

valganciclovir brand name

valcyte

foscarnet brand name

foscavir

cidofovir brand name

vistide

all medications for CMV have to be monitored for CBC and BUN/SCR, but foscarnet also requires what additional monitoring ?

electrolytes and QTc prolongation

Do people with HSV-2 have to complete abstain from sex?

no — just should not have sex during outbreaks (lesions or prodrome are present)

preferred HSV-2 tx in pregnancy

oral acyclovir