Core Dermatology Diagnoses / CategoriesInfectious

Herpes simplex

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Publish date: Posted on
Last updated: April 24, 2024

Keywords #

herpes simplex
herpesvirus
HSV

Diagnosis #

Herpes simplex is a viral infection caused by the virus of the same name. Infection with the two types of herpes simplex virus (HSV) can cause various forms of the disease, depending on the location and involvement of tissues.[1] Examples include labial and genital herpes, herpetic gingivostomatitis, and herpetic whitlow. HSV can be inoculated via mucosal surfaces or small dermal lesions, and afterwards, may remain dormant in ganglion neurons.[2]

Key Concepts #
  • There are two types of herpes simplex viruses: types 1 and 2. Type 1 is more commonly associated with herpes labialis, while type 2 is more commonly associated with genital herpes.
  • Herpes infections are very common, with approximately 50 million individuals affected.
  • The characteristic physical exam findings of herpes infection is not present in every individual.
Epidemiology #

Currently approximately 50 million persons in the United States are infected with HSV-1 and similar numbers for HSV-2 have been reported.[1,3] Primary infection of oral herpes occurs in childhood with about 33% infected by age 5, and 60-90% by adulthood, and 21.9% of adults over the age of 12 have HSV-2 serology.[2,3]

Clinical Features #
  • HSV lesions are characteristically vesicular or ulcerated in nature, with an erythematous base. It is associated with pain and pruritus.
  • Oral herpes, or herpes labialis, is primarily caused by HSV-1. The primary outbreak often causes herpetic gingivostomatitis, while recurrent infections(ie, cold sores)result in a painful rash of the skin and mucous membranes, often affecting the vermillion border of the lips.[2]
  • Genital herpes is primarily caused by HSV-2, though increasing cases of HSV-1 related to genital herpes have been reported.[1] It is associated with painful lymphadenopathy in the groin area.
  • Herpetic whitlow is an infection of the hand caused by HSV, via oral secretions. It is more common in contact sport athletes and healthcare workers, especially dentists.[5]
Differential Diagnoses #
Diagnostic Workup #
No diagnostic workup is indicated for herpes simplex as it is considered a clinical diagnosis. However, the painful multiple vesicular or ulcerative lesions typically associated with HSV may be absent in many infected individuals.[1] If performed, a Tzanck smear reveals eosinophilic intranuclear Cowdry A inclusion bodies. A viral culture of a fresh vesicle can be used to confirm the diagnosis, and a PCR can be done to detect HSV DNA.[2,4,5] A skin biopsy may be utilized as well.
Treatment #

HSV is treated with antivirals, including acyclovir, valacyclovir, famciclovir for the signs and symptoms of herpes infection.[2,4,5] A corticosteroid may be added to the antiviral regimen to reduce risk of ulcerative lesions in recurrent infections.[2]

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/
References #
  1. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR. 2015 Jun 5; 64(3):1-134.
  2. Usatine RP, Tinitigan R. Nongenital herpes simplex virus. Am Fam Physician. 2010 Nov 1; 82(9):1075-1082.
  3. Liesegang TJ. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001; 20(1):1-13.
  4. Gupta R, Warren T, Wald A. Genital herpes. Lancet. 2007; 370:2127-2137.5.Hoff NP, Gerber PA. Herpetic whitlow. CMAJ. 2012 Nov 20; 184(17):E924.
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