Herpes simplex virus infection

Last reviewed: 24 Apr 2022
Last updated: 27 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dysuria (in women)
  • lymphadenopathy
  • genital ulcer
  • oral ulcer
  • fever
More key diagnostic factors

Other diagnostic factors

  • tingling sensation
  • headache/aseptic meningitis
Other diagnostic factors

Risk factors

  • HIV infection (risk factor for clinical disease)
  • 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 behaviour (risk factor for seropositivity)
  • lack of condom use (risk factor for seropositivity)
More risk factors

Diagnostic investigations

1st investigations to order

  • HSV polymerase chain reaction (PCR)
  • viral culture
  • Glycoprotein G-based type-specific serology (gG1 and gG2)
More 1st investigations to order

Treatment algorithm

ACUTE

disseminated visceral involvement: pneumonitis, hepatitis, or CNS involvement (meningitis or encephalitis)

genital disease: first episode, immunocompetent

genital disease: first episode, immunocompromised

genital disease: recurrent episode, immunocompetent

genital disease: recurrent episode, immunocompromised

genital disease: pregnant (36 weeks of gestation)

oral disease: first episode, immunocompetent

oral disease: first episode, immunocompromised

oral disease: recurrent episode, immunocompetent

oral disease: recurrent episode, immunocompromised

ONGOING

genital disease: sexually active or frequent severe recurrences, immunocompetent

genital disease: sexually active or frequent severe recurrences, immunocompromised

oral disease: frequent severe recurrences, immunocompetent

oral disease: frequent severe recurrences, immunocompromised

Contributors

Authors

Benjamin D. Lorenz, MD

Assistant Professor

Division of Hospital Medicine

MedStar Georgetown University Hospital

Washington

DC

Disclosures

BDL declares that he has no competing interests.

Acknowledgements

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

Disclosures

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.

Peer reviewers

Giuseppe Pizzo, DDS

Associate Professor

Department of Surgical, Oncological and Oral Sciences

School of Dentistry

University of Palermo

Palermo

Italy

Disclosures

GP declares that he has no competing interests.

Peter Leone, MD

Professor of Medicine

University of North Carolina at Chapel Hill

Chapel Hill

NC

Disclosures

PL declares that he has no competing interests.

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