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- Presentation
Overview of Herpes Viruses: HSV, Varicella Zoster, Diagnosis, Treatment, and Emerging Therapies
Description
The talk reviewed the first three human herpes viruses: HSV-1, HSV-2, and varicella zoster virus. It emphasized how common HSV-1 and HSV-2 are worldwide, their ability to establish lifelong latency in dorsal root ganglia, and their importance in people with HIV and other immunocompromised states. Clinical differences between primary and recurrent herpes were described, along with typical oral, genital, herpetic whitlow, and disseminated or zoster presentations. Diagnosis was covered with an emphasis on PCR/nucleic acid amplification tests as the preferred method for active lesions, while serology was noted as useful mainly for patients with recurrent symptoms without lesions or in discordant couples. Standard treatment remains acyclovir, valacyclovir, or famciclovir, with IV acyclovir reserved for severe disseminated varicella or complicated disease. Post-herpetic neuralgia management included gabapentin, pregabalin, tricyclics, and topical lidocaine, with steroids not clearly beneficial. Acyclovir-resistant HSV was highlighted as rare but more common in immunocompromised patients, often due to thymidine kinase loss, and treated with cidofovir, foscarnet, reduced immunosuppression, surgery, or emerging agents. The most promising new antiviral discussed was pritelivir, a helicase-primase inhibitor showing encouraging results in resistant cases. The speaker also reviewed vaccines, noting effective varicella and shingles vaccines, possible links between varicella vaccination and reduced dementia risk, and early experimental approaches such as CRISPR-based gene editing and HSV vaccine candidates, though no licensed genital herpes vaccine yet exists.
View moreConclusions
- HSV-1 and HSV-2 remain extremely common worldwide and impose a major clinical and economic burden.
- Herpesviruses establish lifelong latency and can reactivate, especially with aging or immunosuppression.
- Varicella vaccination has markedly reduced primary chickenpox incidence, but shingles incidence has continued to rise in older adults for now.
- Primary HSV and VZV infections tend to be more systemic or widespread, while recurrent disease is usually localized and shorter.
- Asymptomatic HSV shedding is frequent enough that transmission can occur even when lesions are absent.
- PCR-based nucleic acid testing is the preferred diagnostic method for active herpes lesions, while serology is useful only in selected scenarios.
- Point-of-care herpes tests are not yet routine, but new platforms such as LAMP and CRISPR-based assays are emerging.
- Standard antiviral therapy for uncomplicated herpes remains acyclovir, valacyclovir, or famciclovir.
- Post-herpetic neuralgia is best managed first with neuropathic pain agents such as gabapentin or pregabalin, and corticosteroids generally do not prevent it.
- Contrary to expectation, HIV does not appear to increase the overall risk of post-herpetic neuralgia.
- Acyclovir-resistant HSV is uncommon but should be suspected in persistent or atypical lesions, especially in immunocompromised patients.
- When acyclovir resistance is present, cidofovir, foscarnet, immunosuppression reduction, and sometimes surgery may be required.
- Pritelivir is a promising new antiviral that may be highly effective for acyclovir-resistant herpes, including in immunocompromised and HIV-positive patients.
- An effective HSV vaccine is still lacking despite several promising candidates in development.
- Varicella-zoster vaccination is highly effective and may also reduce dementia risk, while recurrent zoster may increase dementia risk.
- CRISPR-based approaches suggest a future possibility of directly targeting latent HSV reservoirs, but this remains preclinical and not ready for routine human use.
- Herpes simplex virus: global infection prevalence and incidence estimates, 2016.#10.2471/blt.19.237149
- CID 2020:70 (15 March) • Wolfson et al.
- Varicella vaccination and herpes zoster incidence in the United States.
- Piret J, Boivin G. Resistance of herpes simplex viruses to nucleoside analogues: mechanisms, prevalence, and management. Antimicrob Agents Chemother 2011;55(2):459–472.#10.1128/aac.00615-10
- M.S. Bowman et al. Urology Case Reports 36 (2021) 101594.
- Effect of Pritelivir Compared With Valacyclovir on Genital HSV-2 Shedding in Patients With Frequent Recurrences.#10.1001/jama.2016.18189
- A natural experiment on the effect of herpes zoster vaccination on dementia.#10.1038/s41586-025-08800-x
- Varicella-zoster virus reactivation and the risk of dementia.#10.1159/000060314
- Targeting herpes simplex virus with CRISPR-Cas9 cures herpetic stromal keratitis in mice.#10.1038/s41587-020-00781-8