Herpes simplex virus in Adult
See also in: Cellulitis DDx,AnogenitalAlerts and Notices
Synopsis
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. Clinical disease occurs with reactivation (spontaneously or with trauma, UV exposure, fever, or immunosuppression) of the latent virus, which travels from the nerve root to innervated skin regions. This occurs in 30%-50% of oral HSV infections and 95% of genital HSV infections. An individual may be coinfected with more than one type of HSV and in more than one location. HSV acquisition at a new site in a previously infected person is designated a nonprimary, first episode infection.
Ninety percent of adults are antibody positive to HSV-1. HSV-2 prevalence is lower, affecting almost a quarter of the US population. Women have a higher seropositivity to HSV-2 than men. Risk factors for genital HSV infection include having multiple sexual partners, lower educational and socioeconomic levels, a man who has sex with men, or human immunodeficiency virus (HIV) infection.
Symptoms of primary disease are usually more severe than recurrent disease and depend upon the site of inoculation. Herpetic gingivostomatitis (usually HSV-1) presents with fever, malaise, bleeding, painful gums, pain upon eating, and sometimes pharyngitis and foul breath. In primary genital herpes, headache, fever, malaise, pain, and dysuria are common. Complications include urinary retention, constipation, and aseptic meningitis. Primary keratoconjunctivitis is associated with pain, eyelid edema, photophobia, and tearing. Localized adenopathy is common with primary infection. Disease occurs 3-7 days after exposure; recovery from a primary episode usually occurs in 2-6 weeks. Disseminated infection and pneumonitis may occur in the immunocompromised. Other complications include bacterial superinfection, radiculoneuropathy, encephalitis, hepatitis, and eczema herpeticum in patients with atopy. Viral folliculitis secondary to HSV (usually inoculated secondary to shaving) has been described. Pregnant individuals with primary HSV infection are at increased risk for severe illness, ie, dissemination and hepatitis, particularly in the third trimester.
Recurrent disease usually lacks constitutional symptoms. Itching, burning, tingling, or pain often precede the skin lesions. Complications include bacterial superinfection, eczema herpeticum, erythema multiforme, Bell palsy, aseptic meningitis, and encephalitis.
HSV infection in HIV-infected patients and other immunodeficiency states with T-cell defects is common and often presents with more severe and chronic disease. Chronic nonhealing, painful ulcers occur, particularly in the perianal location. Others at risk for this include marrow and solid organ transplant patients and patients with lymphoma and leukemia.
Codes
ICD10CM:B00.1 – Herpesviral vesicular dermatitis
SNOMEDCT:
88594005 – Herpes simplex
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Differential Diagnosis & Pitfalls
For both orolabial and genital:- Differentiate from zoster, which also presents with umbilicated vesicles.
- Furunculosis
- Contact dermatitis
- Molluscum contagiosum
- Dermatitis herpetiformis
- Fixed drug eruption
- Dyshidrotic dermatitis
- Insect bites
- Hand-foot-and-mouth disease
- Candidiasis
- Herpangina
- Aphthous stomatitis
- Erythema multiforme
- Reactive infectious mucocutaneous eruption (RIME)
- Chemotherapy-induced mucositis
- Impetigo
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Therapy
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Last Reviewed:12/14/2016
Last Updated:06/07/2022
Last Updated:06/07/2022
Patient Information for Herpes simplex virus in Adult
Overview
Herpes simplex virus (HSV) is a common infection that can cause skin and mouth sores, often called cold sores or fever blisters. The first eruption, or outbreak, is called primary herpes. This is often more severe than secondary, or recurrent, herpes infections.Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) can cause infection. HSV-1 is the most common cause of lesions that appear around the mouth and on the lips. HSV-2 more commonly causes lesions on the genital area, although HSV-1 can also be a cause. Although HSV-2 is most often associated with the genitals, it can occur on virtually any body location. Both conditions are highly contagious and are spread by direct contact with the lesions of another infected individual. The virus can even spread in the absence of symptoms or visible lesions.
The primary herpes episode usually heals in 7-10 days. Affected individuals carry the virus in their bodies for the rest of their lives, and this may lead to recurrences of outbreaks in the same skin area. Most people report burning, itching, and a tingling sensation in the area before the actual lesions appear.
Who’s At Risk
Infection with HSV is very common, and most adults have been exposed. Most people never even know they have been infected, as their immune system suppresses symptoms.Symptoms may be more severe in those with a weak immune system.
Signs & Symptoms
Recurring HSV presents as itching or tingling followed by papules (small solid bumps) that become vesicles (small fluid-filled blisters) that then rupture and then become crusted.Most commonly, primary herpes is seen in children with painful blisters and erosions of the gums and the skin around or lining the mouth. There may also be fever, swollen lymph nodes in the neck, irritability, and a poor appetite. If HSV is introduced on other body sites, there can be painful blisters and sores in that location (finger, face, genitals, etc), with swelling, fever, and swollen lymph nodes.
Self-Care Guidelines
- For primary HSV, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken for pain. Relieving pain is important so that eating and sleeping are possible.
- Drink as much fluid as possible to avoid dehydration.
- Avoid close contact with others, especially children and newborns and those with eczema or a weak immune system, until healed.
When to Seek Medical Care
Although those with mild recurrent herpes do not usually need any medical care, see a medical professional if the condition is bothersome.Treatments
Antiviral medications may be prescribed (acyclovir [Zovirax], valacyclovir [Valtrex], or famciclovir [Famvir]). This can be taken for each outbreak and started at the first signs of the outbreak (such as tingling). People who have recurrent infections that are frequent enough or severe enough may receive daily treatment to decrease the frequency and severity of attacks.Herpes simplex virus in Adult
See also in: Cellulitis DDx,Anogenital