Herpes simplex is a viral infection caused by the herpes simplex virus (HSV). HSV-1 is associated primarily with oral infections, and HSV-2 causes mainly genital infections.
_ Primary Infection
- Symptoms occur from 3 to 7 days after contact (respiratory droplets, direct contact).
- Constitutional symptoms include low-grade fever, headache and myalgias, regional lymphadenopathy, and localized pain.
- Pain, burning, itching, and tingling last several hours.
- Grouped vesicles, usually with surrounding erythema, appear and generally ulcerate or crust within 48 hr.
- The vesicles are uniform in size (differentiating it from herpes zoster vesicles, which vary in size). Scattered erosions covered with exudate may be noted on genitals.
- During the acute eruption the patient is uncomfortable; involvement of lips and inside of mouth may make it unpleasant for the patient to eat; urinary retention may complicate involvement of the genital area.
- Lesions generally last from 2 to 6 wk and heal without scarring.
_ Recurrent Infection
- Generally caused by alteration in the immune system; fatigue, stress, menses, local skin trauma, and exposure to sunlight are contributing factors.
- A cluster of lesions generally evolves within 24 hr from a macule to a papule and then vesicles surrounded by erythema; the vesicles coalesce and subsequently rupture within 4 days, revealing erosions covered by crusts.
- The crusts are generally shed within 7 to 10 days, revealing a pink surface.
- Rapid onset of diffuse cutaneous herpes simplex (eczema herpeticum) may occur in certain atopic infants and adults.
_ Behçet’s syndrome
_ Coxsackie virus infection
_ Stevens-Johnson syndrome
_ Aphthous stomatitis.
_ Herpes zoster
- Direct immunofluorescent antibody slide tests provide a rapid diagnosis.
- Viral culture is the most definitive method for diagnosis; results are generally available in 1 or 2 days. The lesions should be sampled during the vesicular or early ulcerative stage; cervical samples should be taken from the endocervix with a swab.
- Tzanck smear is a readily available test that will demonstrate multinucleated giant cells. However, it is not a highly sensitive test.
- Pap smear will detect HSV-infected cells in cervical tissue from women without symptoms.
- Serologic tests for HSV: immunoglobulin (Ig) G and IgM serum antibodies. Antibodies to HSV occur in 50% to 90% of adults. The presence of IgM or a fourfold or greater rise in IgG titers indicates a recent infection (convalescent sample should be drawn 2 to 3 wk after the acute specimen is drawn).
Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatments.