Herpes simplex virus infection

Herpes simplex virus infection is common and has multiple clinical manifestations.

The classic clinical presentation of vesicles progressing to painful ulcers is unusual; atypical and mild symptoms are common, and most people have unrecognised disease.

Symptoms of oral herpes (herpes labialis) include tingling and burning followed by development of vesicular then ulcerative lesions involving the oropharynx and perioral mucosa.

Symptoms of genital herpes range from asymptomatic to tingling and burning without lesions, to recurrent genital ulcerations.

Antiviral therapy is effective at shortening the duration and severity of an outbreak.

Daily suppressive therapy reduces recurrences by 80% and reduces transmission risk by approximately 50%.

Virological testing (nucleic acid amplification test or viral culture) from the swab of an active lesion is the preferred method to establish diagnosis and distinguish between types 1 and 2.

The major clinical manifestations of infection with herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) are oral, genital, and ocular ulcers. Less commonly, primary or recurrent HSV infections may also present at other sites with neurological, hepatic, or respiratory complications. The primary episode occurs during initial infection with HSV, in which the host lacks an antibody response.

Herpes labialis is an infection of the mouth area and lips, most commonly with HSV-1.

Genital herpes is caused by infection with either HSV-1 or HSV-2. The first clinical episode of genital ulceration may represent either new acquisition of the virus or newly recognised disease with remote acquisition of the virus.

For both HSV-1 and HSV-2, asymptomatic shedding and transmission of the virus may occur in the absence of lesions. HSV establishes latency in neuronal ganglia and periodically reactivates. Most reactivations are asymptomatic but can result in transmission of the virus.

For details of management of ophthalmic HSV infection, see Uveitis and Keratitis. For details of management of suspected HSV encephalitis, see Encephalitis.