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Infección por virus herpes simple

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  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
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Last reviewed: 21 Jan 2026
Last updated: 27 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • disuria (en mujeres)
  • linfadenopatía
  • úlcera genital
  • úlcera oral
  • fiebre
Full details

Other diagnostic factors

  • sensación de hormigueo
  • cefalea/meningitis aséptica
Full details

Risk factors

  • infección por VIH (factor de riesgo para enfermedad clínica)
  • uso de medicamentos inmunosupresores (factor de riesgo para enfermedad clínica)
  • sexo femenino (factor de riesgo para seropositividad)
  • raza negra (factor de riesgo para seropositividad)
  • aumenta con la edad (factor de riesgo para seropositividad)
  • comportamiento sexual de alto riesgo (factor de riesgo para seropositividad)
  • no usar condones (factor de riesgo para seropositividad)
Full details

Diagnostic tests

1st tests to order

  • reacción en cadena de la polimerasa del VHS (PCR)
  • cultivo viral
Full details

Tests to consider

  • serología específica de tipo basada en glucoproteína G (gG1 y gG2)
Full details

Treatment algorithm

ACUTE

Afectación del SNC: encefalitis o meningitis

afectación visceral diseminada: esofagitis, neumonitis o hepatitis

enfermedad genital: primer episodio, inmunocompetente, no embarazada

enfermedad genital: primer episodio, inmunocomprometida, no embarazada

enfermedad genital: episodio recurrente, inmunocompetente, no embarazada

enfermedad genital: episodio recurrente, inmunocomprometida, no embarazada

enfermedad genital: episodio primario o primero, embarazo

enfermedad genital: episodio recurrente, embarazo

enfermedad de la cavidad oral: primer episodio, pacientes inmunocompetentes

enfermedad de la cavidad oral: primer episodio, pacientes inmunocomprometidos

enfermedad de la cavidad oral: episodio recurrente, pacientes inmunocompetentes

enfermedad de la cavidad oral: episodio recurrente, pacientes inmunocomprometidos

ONGOING

enfermedad genital: paciente sexualmente activa o con recurrencias graves frecuentes, inmunocompetente, no embarazada

enfermedad genital: embarazo

enfermedad de la cavidad oral: pacientes con recurrencias graves frecuentes, inmunocompetentes

enfermedad de la cavidad oral: pacientes con recurrencias graves frecuentes, inmunocomprometidos

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. Since completing the 2024 review, BDL has become an employee of Moderna and has resigned as a contributor.

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.

Paul Adamson, MD, MPH

Assistant Clinical Professor of Medicine

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles

CA

Disclosures

PA declares that he has no competing interests.

Nicholas Van Wagoner, MD, PhD

Associate Professor of Medicine

University of Alabama

Birmingham

AL

Disclosures

NVW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Morris-Cunnington M, Brown D, Pimenta J, et al. New estimates of herpes simplex virus type 2 seroprevalence in England: 'high' but stable seroprevalence over the last decade. Sex Transm Dis. 2004;31:243-246. Abstract

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

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.Full text  Abstract

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

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

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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