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Infecção pelo vírus do herpes simples

Last reviewed: 16 Jul 2025
Last updated: 27 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • disúria (em mulheres)
  • linfadenopatia
  • úlcera genital
  • úlcera oral
  • febre
Full details

Other diagnostic factors

  • sensação de formigamento
  • cefaleia/meningite asséptica
Full details

Risk factors

  • infecção pelo vírus da imunodeficiência humana (HIV; fator de risco para doença clínica)
  • uso de medicamentos imunossupressores (fator de risco para doença clínica)
  • sexo feminino (fator de risco para soropositividade)
  • raça negra (fator de risco para soropositividade)
  • idade avançada (fator de risco para soropositividade)
  • comportamento sexual de alto risco (fator de risco para soropositividade)
  • não uso de preservativo (fator de risco para soropositividade)
Full details

Diagnostic investigations

1st investigations to order

  • Reação em cadeia da polimerase do HSV
  • cultura viral
Full details

Investigations to consider

  • Testes sorológicos tipos-específicos para glicoproteína G (gG1 e gG2)
Full details

Treatment algorithm

ACUTE

Envolvimento do SNC: encefalite ou meningite

envolvimento visceral disseminado: esofagite, pneumonite ou hepatite

doença genital: primeiro episódio, imunocompetente, não gestante

doença genital: primeiro episódio, imunocomprometido, não gestante

doença genital: episódio recorrente, imunocompetente, não gestante

doença genital: episódio recorrente, imunocomprometido, não gestante

doença genital: primária ou primeiro episódio, gestante

doença genital: episódio recorrente, gestante

doença oral: primeiro episódio, imunocompetente

doença oral: primeiro episódio, imunocomprometido

doença oral: episódio recorrente, imunocompetente

doença oral: episódio recorrente, imunocomprometido

ONGOING

doença oral: sexualmente ativo ou recorrências graves frequentes, imunocompetente, não gestante

doença oral: sexualmente ativo ou recorrências graves frequentes, imunocomprometido, não gestante

doença genital: gestante

doença oral: recorrências graves frequentes, imunocompetente

doença oral: recorrências graves frequentes, imunocomprometido

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.

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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