By Disease Name > Herpes Simplex

Herpes Simplex

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Herpes Simplex         (grows in culture in 1 to 2 days)

Varicella Zoster Virus  (difficult to grow in culture; may take 2 weeks)

 

 

 

Ted Rosen pearl – puts all immunocompetent patients on suppressive therapy

•decreases viral shedding
•no resistance develops in immunocompetent hosts
•doses = valacyclovir 500QD, or famvir 250 BID, or acyclovir 400BID

 

Ted Rosen pearl – antiviral prophylaxis during entire third trimester of any pregnant woman with history of genital HSV

•dose = valacyclovir 1000mg/day; acyclovir 400mg/TID  (these are higher than normal suppressive doses)

 

 

resistant HSV:   Foscarnet;    still resistant:  cidofovir

•Ted Rosen pearl  - try viroptic (ophthalmic solution) QID to lesion
•1/3 to ¼ of acyclovir resistant cases will respond
•(because viroptic does not need thymidine kinase activation)
•avoids the dangerous and difficult IV meds (listed above)

 

herpes gingivostomatitis = primary HSV infection, not recurrent if history = recurrent, then think "recurrent apthous stomatitis"(because recurrences are outside mouth);  

 

herpetic whitlow – often have secondary lymphangiitis; never I&D or else viremia (vs. bacterial felon – treatment = I&D)