**HERPES SIMPLEX VIRUS (HSV) MODULE**

**TEST QUESTIONS**

1.  Genital herpes is:

    a.  A recurrent, life-long bacterial infection

    b.  A recurrent, life-long viral infection

    c.  A transient infection caused by a protozoal organism

    d.  A transient viral infection

2.  The majority of genital and perirectal herpetic outbreaks in the
    U.S. are caused by HSV-1.

    a.  True

    b.  False

3.  Which of the following statements is true about the prevalence and
    incidence of HSV-2?

    a.  There are over 1.6 million new cases of HSV-2 each year in the
        U.S.

    b.  Most people with HSV-2 have not been diagnosed.

    c.  Fifty percent or more of new cases are asymptomatic or
        unrecognized.

    d.  All of the above

4.  Which of the following statements is true about the transmission of
    HSV?

    a.  The average incubation period is 10 days.

    b.  Likelihood of transmission does not change with increased
        duration of infection.

    c.  HSV is readily inactivated by drying and soap and water.

    d.  Most sexual transmission occurs while the source contact case is
        symptomatic.

5.  In most cases of sexual transmission of genital HSV, the source case
    is asymptomatic.

    a.  True

    b.  False

6.  Sexual transmission of genital herpes is less efficient from

    a.  Women to men

    b.  Men to women

    c.  Transmission efficiency is the same from men to women and from
        women to men.

7.  Up to \_\_% of persons seropositive for HSV-2 antibody have no
    clinical history of anogenital herpes outbreaks.

    a.  75

    b.  80

    c.  90

    d.  95

8.  Which of the following statements is true about the pathogenesis of
    HSV?

    a.  Up to 90% of persons seropositive for HSV-2 antibody have a
        clinical history of anogenital herpes outbreaks.

    b.  Most persons who are seropositive for HSV-2 with no symptoms
        still shed virus from the genital area intermittently.

    c.  Reactivation and viral replication never occur.

    d.  All herpes viruses establish active infection in specific target
        cells.

9.  Which clinical presentation is typical of the first episode with
    primary HSV-2 infection?

    a.  No lesions or symptoms, HSV-1 antibodies may or may not be
        present, HSV-2 antibodies are present

    b.  Lesions present, symptoms usually mild, HSV-1 antibodies may or
        may not be present, HSV-2 antibodies are present

    c.  Lesions present, symptoms usually severe, HSV-1, HSV-2
        antibodies are not present

    d.  Lesions present, symptoms usually moderate, HSV-1 antibodies are
        present, HSV-2 antibodies are not present

10. The median duration of viral shedding in primary infection without
    treatment is:

    a.  Approximately 4 days

    b.  Approximately 12 days

    c.  5-10 days

    d.  2-4 weeks

11. All of the following are true of asymptomatic viral shedding,
    EXCEPT:

    a.  Asymptomatic shedding occurs in almost all HSV-2 seropositive
        persons.

    b.  Rates of asymptomatic shedding are greater with HSV-1 than
        HSV-2.

    c.  Rates of asymptomatic shedding with HSV-2 appear to be decreased
        by the presence of HSV-1 serum antibody.

    d.  The most common sites of asymptomatic shedding are the vulva and
        the perianal area in women and penile skin and the perianal area
        in men.

12. Which of the following is true about aseptic meningitis, a
    complication of genital herpes infection?

    a.  It is more common in women than men.

    b.  It is more common in HSV-1 than HSV-2.

    c.  It is more common in recurrent than primary infection.

    d.  It generally has severe neurologic sequelae.

13. Which of the following factors can affect the severity and frequency
    of clinical manifestations and recurrence rates of genital herpes
    infection?

    a.  Viral type

    b.  Immune status of the host

    c.  Gender

    d.  All of the above

14. Which of the following statements describes non-primary HSV
    infection?

    a.  First infection ever with either HSV-1 or HSV-2

    b.  Disease is more severe than recurrent disease'

    c.  No serum antibody present when symptoms appear

    d.  Newly acquired infection with HSV-1or HSV-2 in an individual
        previously seropositive to the other virus

15. Primary infection without treatment lasts:

    a.  3-4 days

    b.  5-7 days

    c.  10-12 days

    d.  2-4 weeks

16. Which of the following statements is true about recurrent infection
    without treatment?

    a.  Duration is shorter than primary infection.

    b.  HSV-1 infection is much more likely to recur than HSV-2.

    c.  There are usually systemic symptoms associated with the
        recurrent infection.

    d.  HSV-2 will recur slightly more frequently and after a shorter
        period of time in women than in men.

17. Which of the following statements is true about asymptomatic viral
    shedding?

    a.  Most HSV-2 is not transmitted during asymptomatic shedding.

    b.  Rates of asymptomatic shedding in HSV-2 seropositive persons are
        greatest in the first 6 months.

    c.  Presence of serum antibody of HSV-1 seems to decrease rates of
        asymptomatic shedding with HSV-2.

    d.  Asymptomatic shedding occurs less frequently in men with
        established HSV-2 infection.

18. Which type of lab test is considered the gold standard for HSV
    diagnosis?

    a.  Cytology

    b.  PCR assay

    c.  Antigen detection

    d.  Viral culture

19. Which of the following tests is considered better than culture for
    diagnosing HSV if the lesions are healing?

    a.  Type-specific serology

    b.  Antigen detection

    c.  Tzanck smear

    d.  PCR assay

20. Type-specific serologic tests are recommended for all of the
    following reasons EXCEPT:

    a.  To confirm clinical diagnosis

    b.  To diagnose unrecognized infection

    c.  To screen for HSV-1 or HSV-2 infection in the general population

    d.  To manage sex partners of persons with genital herpes

21. Which of the following best describes antigen detection (DFA or EIA)
    testing?

    a.  Preferred test for detecting HSV in spinal fluid; highly
        sensitive and specific; role in diagnosis of genital ulcer
        disease not well-defined

    b.  Rapid and highly specific; fairly sensitive for symptomatic
        shedders; may be better than culture for healing lesions

    c.  Considered the gold standard; preferred test for patients with
        genital ulcers or other mucocutaneous lesions

    d.  Insensitive and nonspecific; should not be relied on for HSV
        diagnosis

22. Which of the following is true regarding systemic antiviral therapy?

    a.  It partially controls symptoms and signs of herpes episodes when
        used to treat first clinical and recurrent episodes or when used
        as daily suppressive therapy.

    b.  It reduces the frequency of genital herpes recurrences by
        40%-50% when used as suppressive therapy for patients who have
        frequent recurrences.

    c.  It should never be provided to patients to self-initiate
        treatment when symptoms begin.

    d.  It is less effective than topical antiviral treatment for
        management of severe disease.

23. HSV systemic antiviral chemotherapy includes which of the following
    oral medications?

    a.  Acyclovir

    b.  Valacyclovir

    c.  Famciclovir

    d.  All of the above

24. Which of the following is true about episodic treatment of recurrent
    episodes of HSV disease?

    a.  It can ameliorate or shorten the duration of lesions

    b.  Patient should self-initiate the medication

    c.  Successful treatment requires initiation of therapy within 1 day
        of lesion onset

    d.  All of the above

25. All of the following are true of herpes in pregnancy, EXCEPT:

    a.  The risk for transmission from infected mother to neonate is
        30%-50% in women who acquire genital herpes near the time of
        delivery.

    b.  The risk for transmission from infected mother to neonate is
        \<1% in women with histories of recurrent genital herpes or who
        acquire genital HSV during the first half of pregnancy.

    c.  Most specialists recommend that women with recurrent genital
        herpetic lesions at the onset of labor be delivered abdominally.

    d.  Most specialists recommend that women with histories of
        recurrent genital herpes who have no symptoms or signs of
        genital herpes or its prodrome at the onset of labor be
        delivered abdominally.

26. Asymptomatic sex partners of persons diagnosed with genital herpes
    should be:

    a.  Counseled about the risk of asymptomatic transmission

    b.  Taught to recognize symptoms of genital herpes

    c.  Offered type-specific serologic testing for HSV infection

    d.  All of the above

27. Patients with genital herpes should be informed that:

    a.  Sexual transmission of HSV can occur during asymptomatic
        periods.

    b.  Stressful events may trigger recurrences.

    c.  The frequency of outbreaks generally decreases with increasing
        duration of the infection.

    d.  All of the above

28. Which of the following is true of the relationship between HSV and
    HIV infection?

    a.  Genital ulcers have no effect on the risk of HIV transmission
        and acquisition.

    b.  Lesions caused by HSV are uncommon in HIV-infected persons.

    c.  Increased doses of antiviral drugs have been demonstrated to be
        beneficial in HIV-infected persons with genital herpes.

    d.  All of the above

29. Patient education should include all of the following, EXCEPT:

    a.  HSV can be transmitted sexually during asymptomatic periods.

    b.  The frequency of outbreaks generally decreases with increasing
        duration of infection.

    c.  Condom use can protect against HSV transmission regardless of
        whether the infected area or site of infection is covered by the
        condom.

    d.  Risks of neonatal infection should be explained to women and
        men.

30. Patients with genital herpes should be advised to:

    a.  Abstain from sexual activity with uninfected partners when
        prodromal symptoms are present.

    b.  Inform their providers of their HSV status, if they are women of
        child-bearing age.

    c.  Inform future sex partners that they have genital herpes before
        initiating a sexual relationship.

    d.  All of the above