Review Question - QID 106497

The female presents with an outbreak of genital herpes caused by herpes simplex virus type 2 (HSV-2), which establishes a latent infection in the sacral nerve ganglion.

HSV-2 is an enveloped linear dsDNA virus that is primarily transmitted sexually or perinatally. The initial infection is established within the mucosal epithelium. The virus then travels up to the sacral ganglion resulting in a lifelong latent infection. Stress and other stressors can reactivate the virus resulting in subsequent outbreaks of genital herpes which are painful vesicles accompanied by systemic effects of fever, malaise, and myalgia. Treatment can consist of acyclovir which requires viral thymidine kinase (TK) for activation; thus, it is not useful in viruses without TK.

Beauman reviews genital herpes stating that the strongest predictor for infection is the number of lifetime partners and that most spreading of the virus is during the asymptomatic phase. The infection begins with the skin prodrome followed by systemic symptoms including headache, fever, and inguinal lymphadenopathy. The lesions begin as papules/vesicles with an erythematous base that progress to erosions. These lesions will crust over and heal without any scars.

Roett et al. discuss the treatment of genital herpes. The first outbreak is typically treated with 7-10 days of oral acyclovir; subsequent outbreaks are treated only for 5 days. Other antivirals with easier dosing regimens and oral bioavailability include famciclovir or valacyclovir.

Figure A shows an outbreak of genital herpes within the vagina. Figure B shows a Tzanck smear of a genital herpetic lesion. The smear shows multinucleated giant cells in this Giemsa stain. Illustration A shows a penis with herpetic lesions. Illustration B is a Tzanck smear showing a Cowdry Type A inclusions, which are intranuclear eosinophilic viral bodies surrounded by a halo (arrow).

Incorrect Answers:
Answer 2: Varicella zoster virus establishes a latent infection in the dorsal root ganglion.
Answer 3: HSV-1 establishes a latent infection in the trigeminal nerve ganglion.
Answer 4: Ebstein-barr virus establishes a latent infection in B cells.
Answer 5: HIV establishes a latent infection in CD4+ T cells.