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Herpes simplex virus infection

Last reviewed: 23 Sep 2025
Last updated: 27 Feb 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • dysuria (in women)
  • lymphadenopathy
  • genital ulcer
  • oral ulcer
  • fever
Detalhes completos

Outros fatores diagnósticos

  • tingling sensation
  • headache/aseptic meningitis
Detalhes completos

Fatores de risco

  • HIV infection (risk factor for clinical disease)
  • use of immunosuppressive medications (risk factor for clinical disease)
  • female sex (risk factor for seropositivity)
  • black race (risk factor for seropositivity)
  • increasing age (risk factor for seropositivity)
  • high-risk sexual behavior (risk factor for seropositivity)
  • lack of condom use (risk factor for seropositivity)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • HSV polymerase chain reaction (PCR)
  • viral culture
Detalhes completos

Investigações a serem consideradas

  • Glycoprotein G-based type-specific serology (gG1 and gG2)
Detalhes completos

Algoritmo de tratamento

AGUDA

CNS involvement: encephalitis or meningitis

disseminated visceral involvement: esophagitis, pneumonitis, or hepatitis

genital disease: first episode, immunocompetent, nonpregnant

genital disease: first episode, immunocompromised, nonpregnant

genital disease: recurrent episode, immunocompetent, nonpregnant

genital disease: recurrent episode, immunocompromised, nonpregnant

genital disease: primary or first-episode, pregnant

genital disease: recurrent episode, pregnant

oral disease: first episode, immunocompetent

oral disease: first episode, immunocompromised

oral disease: recurrent episode, immunocompetent

oral disease: recurrent episode, immunocompromised

CONTÍNUA

genital disease: sexually active or frequent severe recurrences, immunocompetent, nonpregnant

genital disease: sexually active or frequent severe recurrences, immunocompromised, nonpregnant

genital disease: pregnant

oral disease: frequent severe recurrences, immunocompetent

oral disease: frequent severe recurrences, immunocompromised

Colaboradores

Autores

Benjamin D. Lorenz, MD

Assistant Professor

Division of Hospital Medicine

MedStar Georgetown University Hospital

Washington

DC

Declarações

BDL declares that he has no competing interests. Since completing the 2024 review, BDL has become an employee of Moderna and has resigned as a contributor.

Agradecimentos

Dr Benjamin D. Lorenz would like to gratefully acknowledge Dr Christine Johnson and Dr Anna Wald, previous contributors to this topic.

Declarações

CJ reports funding from AiCuris; grants from Agenus, Gilead, Genocea, Sanofi, and Vical to conduct clinical research studies; and royalties from Up To Date. AW reports grants from Agenus, Gilead, Genocea, Sanofi, and Vical to conduct clinical research studies. AW receives royalties from Up To Date. AW is an NIH grant recipient (NIH AI30731 and AI071113) and a consultant for Aicuris, Eisai, and Amgen.

Revisores

Giuseppe Pizzo, DDS

Associate Professor

Department of Surgical, Oncological and Oral Sciences

School of Dentistry

University of Palermo

Palermo

Italy

Declarações

GP declares that he has no competing interests.

Paul Adamson, MD, MPH

Assistant Clinical Professor of Medicine

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles

CA

Declarações

PA declares that he has no competing interests.

Nicholas Van Wagoner, MD, PhD

Associate Professor of Medicine

University of Alabama

Birmingham

AL

Declarações

NVW declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Centers for Disease Control and Prevention. Morbidity and mortality weekly report: sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication].Texto completo

Patel R, Kennedy OJ, Clarke E, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS. 2017 Dec;28(14):1366-79.Texto completo  Resumo

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 220: management of genital herpes in pregnancy. May 2020 [internet publication].Texto completo

British Association for Sexual Health & HIV; Royal College of Obstetricians and Gynaecologists. Management of genital herpes in pregnancy. Oct 2014 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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