herpes%20simplex%20virus%20infection
HERPES SIMPLEX VIRUS INFECTION
Primary herpes simplex virus (HSV) infection is first infection with either herpes simplex virus-1 (HSV-1) or herpes simplex virus-2 (HSV-2) in individuals who do not have antibodies to either HSV-1 or HSV-2.
First episode-non primary infection is infection with either HSV-1 or HSV-2 in individuals who have previously existing antibodies against HSV-1 or HSV-2 respectively.
Recurrent HSV infection results from reactivation of latent virus. It is usually brought about by triggering factors eg UV light, immunosuppression.
Orolabial HSV disease is mostly caused by HSV-1 that occurs most commonly in children <5 years of age. It is transmitted through close contact with individuals who have active viral shedding.
Genital HSV disease is caused by HSV-2 that is the usual cause of herpes genitalis. It typically occurs in adults and transmitted through sexual contact.

Prevention

  • Educate patient on how to prevent transmission by:
    • Abstaining from sexual contact during lesion recurrences or prodromes
    • Limiting the number of sexual partners
    • Informing sexual partner or former sexual partner(s) of diagnosis to prevent further transmission; advising partners to seek evaluation & treatment
    • Understanding that asymptomatic viral shedding may cause transmission
    • Using a condom to protect against transmission (not foolproof)

Counselling

Patient & Parent

  • Reduce patient’s anxiety & help patients to cope w/ the infection by educating them on the natural history of the disease, recurrent episodes, antiviral treatments, sexual relationships & perinatal transmission
  • Discuss treatment options:
    • Episodic treatment vs suppressive treatment
    • If patient has ≥6 episodes/year, consider suppressive treatment
    • Suppressive treatment may incur higher costs & inconvenience
      • Increase fluid intake to dilute urine

Follow Up

  • Interrupt treatment after 6 months-1 year to assess frequency of recurrence
  • Restart treatment if high rate of recurrences
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