Viral Infections Key Points

• Herpes simplex virus type 1 (HSV-1) is the most common cause of oral herpes infection (80%). HSV-2 is the primary pathogen in genital herpes (70%-90%). Both can cause oral or genital lesions.

• HSV-1 and HSV-2 are characterized by a primary infection, latent periods, asymptomatic shedding, and reactivation.

• Approximately 10% to 20% of the U.S. population develop zoster, but rates are likely to decrease with VZV vaccine for children.

• Corneal involvement should be suspected when herpes zoster involves the tip of the nose and is an ophthalmologic emergency because it can lead to blindness.

• For herpes zoster, antiviral therapy (acyclovir, valacyclovir, famciclovir) should by started within 3 days of onset of symptoms to reduce disease severity and postherpetic neuralgia.

• Human papillomavirus types 6 and 11 are associated with condylomata acuminata (genital warts); HPV types 16 and 18 are associated with carcinoma. The quadrivalent HPV vaccine is active against HPV types 6, 11, 16, and 18.

• Molluscum contagiosum is a common, self-limited viral infection most often affecting children. It is considered sexually transmitted in adults.

• Lesions of molluscum usually resolve spontaneously over months to years; with or without treatment, lesions can leave pitted scars.

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