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More about Herpes simplex virus
There are two types of Herpes simplex virus (HSV).
- Type 1 virus typically causes lesions ("cold sores") around the mouth or nose. It is transmitted from direct and indirect contact (e.g., kissing, touching, using the same glass or towel) with individuals who carry the virus.
- Type 2 virus usually produces lesions in the genital region of the body. It is commonly transmitted through sexual intercourse.
Both types of HSV remain in the body after the initial attack. Recurrence of outbreaks happens at irregular intervals and can be caused by many factors. The virus is contagious before and during outbreaks. Thus, to avoid spreading HSV, contact with others should be avoided not only when lesions are present, but also when symptoms of recurrence (burning, tingling, itching, tenderness) are sensed.
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Blistering, ulcerative skin lesion due to H. simplex virus. |
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Lid lesion due to H. simplex virus; fluorescein staining. |
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Inappropriately treated with steroids. Ulcerative corneal involvement increases with steroid treatment. |
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Inappropriately treated with steroids. Ulcerative corneal involvement increases with steroid treatment. |
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Periorbital swelling and skin lesion below eye. Globe fine; no pain. More ulcerative 2 days prior; not crusted. Lasts for about a week and then goes away. Oral acyclovir taken when tingly. Culture results: H. simplex. |
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Not always classic dendritic . . . |
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Not always classic dendritic . . . |
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Geographic ulcer. Had been treated with steroids. Risk of disciform keratitis. |
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Disciform keratitis; immune reaction of stroma. Hard to treat. |
Treatment of choice for Herpes simplex keratitis:
Viroptic (1% trifluridine solution) from Monarch Pharmaceuticals.
- q2h x 4-5 days, then q4h x 7-10 days, then taper by 1-2 weeks. Some taper several weeks.
- Good activity against both HSV Types 1 and 2.
- Heals most herpetic ulcers in 5-8 days.
- Watch out for toxicity (thimerosal preserved). Must refrigerate.
- Viroptic is expensive; generic trifluridine available.
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Other treatment options: |
Oral antivirals
- Zovirax (acyclovir)
400mg 5x/day for 7 days
generic available
- Famvir (famciclovir)
250mg tid for 7 days
- Valtrex (valacyclovir)
500mg tab tid for 7 days
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Helpful in patients with . . .
- An allergy to Viroptic
- Primary HSV blepharodermatitis
- Active stromal keratitis
- Children with epithelial keratitis
- Recurrrent epithelial or stromal keratitis (see Herpetic Eye Disease Study)
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