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- Characteristic vesicular rash primarily located in oral and genital regions as the result of infection with:
- Herpes simplex virus (HSV)-1 blisters mostly on lips, in mouth, face, eyes
- HSV-2 primarily genital herpes, although cross-reactivity is common (HSV-1 can cause genital sores through oral–genital contact)
- Associated with a wide range of sequelae. Complexity and variation of presentation depends on the age and immune status of host, whether the infection is primary or recurrent and the degree of dissemination.
- Viral shedding is typically greatest in the first (primary) infection and lessens with recurrences.
- Meningitis/encephalitis and pneumonia are serious systemic manifestations associated with HSV infection.
- Predominant age: affects all ages; however, most HSV-1 is acquired in childhood, and most HSV-2 is acquired in young–middle adulthood.
- Predominant sex: male = female
- >1 million new cases of HSV per year
- HSV can reactivate, causing recurrent disease.
- Widespread; 1–25% of adults may shed HSV-1 or HSV-2 at any given time. Many are unaware of their infection status.
- Prevalence of antibodies to HSV-1 is 90% by adulthood in the general population. 30% of adults have antibodies to HSV-2.
Etiology and Pathophysiology
HSV-1 and HSV-2 are double-stranded DNA viruses from the family Herpesviridae. HSV-1 and HSV-2 are transmitted by contact with infected skin during periods of viral shedding. Transmission also occurs vertically during childbirth. Most often, HSV-1 is associated with oral lesions and HSV-2 with genital lesions.
- Immunocompromised state
- Chemotherapy, malignancy/chronic disease states such as diabetes or AIDS, old age
- Atopic eczema, especially in children
- Prior HSV infection
- Sexual intercourse with infected person (Condoms help minimize HSV transmission, but lesions outside condom-protected areas can spread virus.)
- Occupational exposure
- Dental professionals at higher risk for HSV-1 and resulting herpetic whitlow
- Neonatal herpes simplex: Primary infection is life-threatening and usually acquired by vaginal birth to an infected mother; risk is greatest in mothers with primary genital herpes infection; incubation is usually from 5 to 7 days (rarely 4 weeks); cutaneous, mucous membrane, or ocular signs seen in only 70%
- If active lesions are present, avoid direct contact with immunocompromised people, elderly, and newborns.
- Hand hygiene
- Kissing, sharing beverages, and sharing utensils/toothbrushes can transmit HSV.
- Genital herpes: Avoid sexual contact if active lesions (herpes simplex is also transmitted when disease appears to be inactive); discuss condom benefits and limits; consider antiviral therapy to reduce viral shedding; encourage safe sex.
Commonly Associated Conditions
- Erythema multiforme: 50% of cases associated with HSV-1 or HSV-2
- Screen all severe, treatment-resistant, or unusual HSV for concurrent HIV infection.