PA Uses VisualDx to Guide Next Steps in Diagnosis and Treatment

A PA at the University of Missouri shares how VisualDx helped guide next steps in her patient’s diagnosis and treatment:

I was seeing a young male patient with vesicles over the lips and did not know what to do. Using VisualDx, I was able to narrow down my differential, order an HSV/ VZV culture, and diagnose herpes simplex. Thanks!

What is herpes simplex virus?

Herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) infections (cold sores, fever blisters, herpes gladiatorum, scrum pox, herpetic whitlow, herpes progenitalis) are common worldwide, usually affecting the orolabial and genital regions, although any skin area may be affected.

Infection is acquired through contact with contaminated saliva or other body fluids during periods of viral shedding. Primary infection denotes the initial inoculation episode, which may be subclinical or cause significant disease, usually in children. The virus establishes lifelong latency in the dorsal root ganglia.

Ninety percent of adults are antibody positive to HSV-1. HSV-2 prevalence is lower, affecting almost a quarter of the US population.

What should we be aware of when making a diagnosis?

In primary disease, 2-4 mm vesicles, erosions, or ulcers are scattered broadly over the area of primary infection or they may coalesce. They are painful. In recurrent disease, a localized group or groups of umbilicated (with central depressions) vesicles and vesiculopustules, or erosions, on an erythematous base are seen.

How can we treat this?

Treatment involves supportive care and antiviral therapy. The choice of regimen will depend largely on the area or areas of the body affected.

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