Management Of Herpes Simplex Virus Research Articles

Joint British Association for Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists national UK guideline for the management of herpes simplex virus (HSV) in pregnancy and the neonate (2024 update).

This updated national UK guideline offers recommendations on the management of genital herpes simplex virus (HSV) in mothers and pregnant people during pregnancy and within 4 weeks following birth. It includes recommendations for first episode and recurrent HSV, HSV in preterm pre-labour rupture of membranes and in co-infection with HSV and HIV. Recommendations around management of the neonate are made, on prevention of postnatal transmission, management of breastfeeding, and the management of clinically discordant couples. This guideline is aimed at healthcare professionals working in sexual health clinics, maternity units, and those working on postnatal wards and neonatal units in the UK. However, the principles of the recommendations should be adopted across all services, including community care.

Improving polymerase chain reaction diagnostic rates for herpes simplex keratitis: results of a pilot study.

Laboratory confirmation is crucial for diagnosis and management of herpes simplex virus (HSV) keratitis. However, the sensitivity of polymerase chain reaction (PCR) in keratitis is low (25%) compared with that of mucocutaneous disease (75%). We developed an educational intervention aimed at improving the diagnostic yield of PCR. The medical records of keratitis cases seen at the emergency department of a London tertiary ophthalmic referral hospital over two distinct periods, before and after an educational program on swab technique, were reviewed retrospectively. A total of 252 HSV cases were included. Increases in the laboratory-confirmed diagnosis of HSV-1 were observed, in both first presentations (11.1%-57.7%) and recurrent cases (20%-57.6%). The rate of positive HSV-1 PCR in eyes with an epithelial defect increased from 19% pre-intervention to 62% post intervention. Notably, 3% were positive for varicella zoster virus DNA, and there was a single case of Acanthamoeba keratitis. Our results suggest that, with proper swabbing technique, PCR may be more sensitive than previously reported.

Neonatal herpes simplex virus infection: From the maternal infection to the child outcome.

This review examines the recent literature on the management of herpes simplex virus (HSV) infections in neonates. We summarized the three clinical categories of maternal HSV infection during pregnancy (primary first episode, nonprimary first episode, or recurrent episode) and the mechanisms of fetal damage. Considering when the transmission of the infection from the mother to the fetus/newborn occurs, three types of neonatal infection can be distinguished: intrauterine infection (5% of cases), postnatal infection (10% of cases), and perinatal infections (85% of cases). Neonatal presentation could range from a limited disease with skin, eye, and mouth disease to central nervous system disease or disseminated disease: the treatment with acyclovir should be tailored according to symptoms and signs of infection, and virological tests. These children need a multidisciplinary follow-up, to timely intercept any deviation from normal neurodevelopmental milestones. Prevention strategies remain a challenge, in the absence of an available vaccine against HSV.

Clinical features and therapeutic management of herpes simplex virus 1 and 2 (HSV-1 and HSV-2) infections: what'up in 2020?

Clinical features and therapeutic management of herpes simplex virus 1 and 2 (HSV-1 and HSV-2) infections: what'up in 2020?

Herpes simplex virus of the nose masquerading as invasive fungal sinusitis: A pediatric case series

The management of invasive fungal sinusitis differs greatly from the management of herpes simplex virus (HSV) of the nose in immunocompromised patients. However, the diagnosis may be uncertain and a delay in treatment can lead to mortality. Here we describe the successful medical management of a series of immunocompromised pediatric patients with HSV lesions of the nose with the initial concern for invasive fungal sinusitis. The diagnosis of HSV herpes was supported by positive polymerase chain reaction (PCR) testing of the nasal lesion. To our knowledge, these are the first cases described in the pediatric literature, emphasizing the need to include this entity on the differential.

Management of herpes simplex virus epithelial keratitis.

To review recent advancements in the management of herpes simplex virus (HSV) epithelial keratitis. Trifluridine eye drop, acyclovir (ACV) ointment, ganciclovir gel, and oral ACV are still the main therapeutic agents. Cryopreserved amniotic membrane has been recently used as an adjuvant treatment. Resistance to ACV has become a concerning issue. The animal models of HSV vaccine are able to reduce HSV keratitis. New antivirals are under development. Current cases of HSV epithelial keratitis are manageable with available medications, but new advancements are required to decrease disease burden in the future. HSV vaccine can be revolutionary.

No. 208-Guidelines for the Management of Herpes Simplex Virus in Pregnancy.

To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. VALIDATION: These guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. The Society of Obstetricians and Gynaecologists of Canada.

Antiviral resistance in herpes simplex virus and varicella-zoster virus infections: diagnosis and management.

Aciclovir (ACV) is the first-line drug for the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Long-term administration of ACV for the treatment of severe infections in immunocompromised patients can lead to the development of drug resistance. Furthermore, the emergence of isolates resistant to ACV is increasingly recognized in immunocompetent individuals with herpetic keratitis. This review describes the mechanisms involved in drug resistance for HSV and VZV, the laboratory diagnosis and management of patients with infections refractory to ACV therapy. Genotypic testing is more frequently performed for the diagnosis of infections caused by drug-resistant HSV or VZV isolates. Molecular biology-based systems for the generation of recombinant viruses have been developed to link unknown mutations with their drug phenotypes. Fast and sensitive methods based on next-generation sequencing will improve the detection of heterogeneous viral populations of drug-resistant viruses and their temporal changes during antiviral therapy, which could allow better patient management. Novel promising compounds acting on targets that differ from the viral DNA polymerase are under clinical development. Antiviral drug resistance monitoring for HSV and VZV is required for a rational use of antiviral therapy in high-risk populations.

Herpes simplex virus drug-resistance

Acyclovir (ACV) is the first-line treatment for the management of herpes simplex virus 1 (HSV-1) and 2 (HSV-2) diseases. Long-term administration of the drug for the treatment of chronic infections in the immunocompromised host can lead to the development of ACV-resistance. This review provides an update of the mutations linked to drug-resistance and issues to be considered in the management of HSV infections refractory to antiviral therapy. Recent data have shown that HSV drug-resistance should be taken into account not only in immunocompromised individuals but also in immunocompetent persons when HSV infections involve 'immune-privileged sites'. Thus, drug-resistance typing is recommended in cases of ACV unresponsive herpetic keratitis and herpes simplex encephalitis. Several issues regarding HSV drug-resistance were highlighted by recent studies. Phenotypic and genotypic antiviral resistance may vary not only from different compartments but also over time, highlighting the importance of characterizing longitudinal HSV isolates from all sites. Combination therapy should be considered when viruses with distinct phenotype/genotype are identified at one or at distinct body sites. Surveillance of HSV drug-resistance is highly recommended in immunocompromised patients and in immunocompetent individuals with infections implicating 'immune-privileged sites' to rationally adapt antiviral treatment.

Differentiating viral skin infections, part 2

British Journal of School NursingVol. 7, No. 7 DermatologyDifferentiating viral skin infections, part 2Jean WatkinsJean WatkinsSearch for more papers by this authorJean WatkinsPublished Online:16 Aug 2013https://doi.org/10.12968/bjsn.2012.7.7.331AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bhatia A (2012) Molluscum contagiosum—Medscape. http://emedicine.medscape.com/article/910570-overview (accessed 5 September 2012 Google ScholarDavis C (2011) Shingles. www.emedicinehealth.com/shingles/article_em.htm (accessed 5 September 2012 Google ScholarDavis C (2012) Oral herpes (HSV-1) (Herpes of the Mouth). www.emedicinehealth.com/oral_herpes/page7_em.htm (accessed 5 September 2012 Google ScholarDiaz M (2011) Herpes zoster ophthalmicus. http://emedicine.medscape.com/article/783223-overview (accessed 5 September 2012 Google ScholarGautier A, Breuer J, Carrington D, Martin M, Rèmy V (2009) Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect 137: 37–8 Google Scholar Health Protection Agency (2010) Guidance on infection control in schools and other childcare settings. www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947358374 (accessed 5 September 2012 Google ScholarLin C (2011) Eczema herpeticum—DermNet NZ. http://dermnetnz.org/viral/eczema-herpeticum.html (accessed 5 September 2012 Google Scholar NHS Choices (2010) Treating molluscum contagiosum. www.nhs.uk/Conditions/Molluscumcontagiosum/Pages/Treatment.aspx (accessed 5 September 2012 Google ScholarMoney D, Steben M (2008) Guidelines for the management of herpes simplex virus in pregnancy. J Obstet Gynaecol Can 30(6): 514–26 Crossref, Google Scholar NHS Choices (2012) Herpes simplex eye infections. www.nhs.uk/conditions/Herpes-simplex-eyeinfections/Pages/Introduction.aspx (accessed 5 September 2012 Google Scholar FiguresReferencesRelatedDetails 1 September 2012Volume 7Issue 7ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 16 August 2013 Published in print 1 September 2012 Information© MA Healthcare LimitedPDF download

Case report: Benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression

Herpes simplex virus (HSV) infection is rarely considered in the differential diagnosis of severe acute hepatitis and disseminated infection in immunocompetent adults. A case of disseminated HSV-1 infection in an 82-year-old woman initially presenting with neurological problems, signs of meningitis and prominent hepatitis was investigated. Initial diagnosis, monitoring, and follow-up were based on the application of molecular methods to cerebrospinal fluid, serum, and liver tissue samples from this patient. Following an initial full recovery, the patient presented delayed intracerebral haemorrhage and diffuse arthralgia. This atypical case, with delayed secondary progression, highlights the wide range of clinical features of HSV infection and the benefits of monitoring viral load by quantitative real-time polymerase chain reaction (PCR) during patient management.

Review: Identifying potential pitfalls in conventional herpes simplex virus management

In recent years, it has become increasingly clear that genital ulcers from herpes simplex virus (HSV) are associated with HIV acquisition. In light of this evolving synergy in transmission and the availability of effective antiviral therapy, proper diagnosis and management of HSV becomes increasingly important. Unfortunately, conventional HSV management is founded on several popular misconceptions. Herein, we hope to dispel these common misconceptions and expand the current model of herpetic reactivation. By doing so, we aimed to unveil potential pitfalls in current herpetic management.

Guidelines for the Management of Herpes Simplex Virus in Pregnancy

ObjectiveTo provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. OutcomesMore effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. EvidenceMedline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. ValuesRecommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. Recommendations1.Women’s history of genital herpes should be evaluated early in pregnancy. (III-A)2.Women with known recurrent genital herpes simplex virus (HSV) should be counselled about the risks of transmission of HSV to their neonates at delivery. (III-A)3.At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV. (II-2A)4.Women with known recurrent genital HSV infection should be offered acyclovir or valacyclovir suppression at 36weeks’ gestation to decrease the risk of clinical lesions and viral shedding at the time of delivery and therefore decrease the need for Caesarean section. (I-A)5.Women with primary genital herpes in the third trimester of pregnancy have a high risk of transmitting HSV to their neonates and should be counselled accordingly and should be offered a Caesarean section to decrease this risk. (II-3B)6.A pregnant woman who does not have a history of HSV but who has had a partner with genital HSV should have type-specific serology testing to determine her risk of acquiring genital HSV in pregnancy before pregnancy or as early in pregnancy as possible. Testing should be repeated at 32 to 34weeks’ gestation. (III-B) ValidationThese guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC. SponsorThe Society of Obstetricians and Gynaecologists of Canada

Survey of resistance of herpes simplex virus to acyclovir in northwest England.

Acyclovir (ACV) has been used for more than 15 years in the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) disease. The present survey was undertaken to assess the level of ACV resistance in the population. More than 2,000 HSV isolates from both immunocompetent and immunocompromised patients in northwest England were collected over a 2-year period and tested for sensitivity to ACV. These studies suggested a prevalence of resistance of approximately 0.1 to 0.6% in immunocompetent individuals, with no apparent difference in prevalence between treated and untreated groups. In line with previous studies, the prevalence of resistance in treated immunocompromised individuals was approximately 6%.

Sensitivity monitoring of clinical isolates of herpes simplex virus to acyclovir.

Zovirax (acyclovir, ACV) is now widely accepted as a safe and effective treatment for the management of herpes simplex virus (HSV) infections in normal and immunocompromised patients. However, a common concern with regard to the widespread use of any antimicrobial agent is resistance. The virus specific mechanism of action of ACV involves two virus encoded enzymes, thymidine kinase (TK) and DNA polymerase. Any alteration in the genes coding for these two enzymes would therefore be expected to confer resistance. The findings from two extensive resistance monitoring programs have shown that in immunocompetent patients receiving ACV for the management of acute HSV disease, the incidence of resistance is extremely rare. The situation in the immunocompromised is different. In this patient group HSV disease is severe and protracted often requiring prolonged therapy thus increasing the exposure of the virus to drug. As a result HSV isolates resistant to ACV have occasionally been recovered. Biochemical and genetic analysis of the resistant clinical isolates has shown that resistance in the most part is due to an inability of the virus to produce TK which mirrors the findings with cell culture derived resistant virus. Laboratory studies would indicate that TK-deficient virus would have little clinical impact. Significantly, resistance has rarely been attributed to alterations in the substrate specificity of TK or DNA polymerase. The biological significance of these mutants is unclear but to date there has been no evidence of transmission of resistant virus.

Controlling herpes simplex virus infections: is intracellular immunization the way of the future?

The available approaches to the management of herpes simplex virus (HSV) infections currently consist primarily of chemotherapy and the possibility of preventive vaccination. In this review, we explore the potential of a third approach based on recent advances in molecular biology and genetic engineering which renders cells resistant to viral infection. This form of antiviral gene therapy, termed “intracellular immunization” by Baltimore (1988), involves the intracellular expression of a variety of molecular species specifically designed to inhibit targeted virus replication. The utility of such an approach lies in the direct application of knowledge pertaining to molecular mechanisms involved in viral pathogenesis to precisely interrupt lytic infection through the generation of virus-resistant cells. Such strategies may be particularly useful in the management of intracel-lular pathogens which are capable of evading the immune system or in circumstances in which knowledge of molecular pathogenic mechanisms far surpasses the ability to develop appropriate therapeutic drugs or vaccines. In this article, the basic concepts of intracellular immunization, relevant aspects of HSV molecular biology, and studies utilizing antiviral gene therapy to prevent HSV infection will be reviewed.KeywordsHuman Immunodeficiency VirusHuman Immunodeficiency Virus TypeHerpes Simplex Virus TypeRibonucleotide ReductaseHerpes Simplex Virus InfectionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Update on acyclovir: Oral therapy for herpesvirus infections

The results of the major human clinical trials on oral acyclovir are reviewed, and the pharmacokinetics, adverse effects, and role of oral acyclovir in the management of herpes simplex virus (HSV) infections are discussed. Clinical studies have demonstrated the effectiveness of oral acyclovir in causing significant reductions in the duration of viral shedding, development of new lesions, and time to crusting and healing in several clinical situations. The drug appears to achieve the most dramatic results in the treatment of initial primary genital herpes infections. Oral acyclovir also has a potential role in suppressing reactivations of HSV infections in immunocompromised patients or patients experiencing greater than 10-12 recurrences of genital herpes per year. Most trials have used 200-mg capsules administered five times daily for 5-10 days for treating acute infections. Reduced doses have been successful for suppressive therapy. Acyclovir does not alter the frequency of recurrence once treatment has been discontinued. The absolute bioavailability of oral acyclovir is approximately 20%, and plasma concentrations are about one tenth of those achieved after a typical i.v. infusion. The relationship between plasma concentration and clinical response has not been established. The half-life is 3-4 hours, and the predominant route of elimination is via renal excretion and tubular secretion. Clinical studies have consistently reported minimal adverse effects with oral acyclovir. Conservative use is justified by the potential development of resistant viral strains. The extent and clinical importance of resistant viral selection remain to be determined. Oral acyclovir represents an advance in the development of a nontoxic antiviral agent suitable for both hospitalized and ambulatory patients that should be recommended for formulary inclusion.