Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- disúria (em mulheres)
- linfadenopatia
- úlcera genital
- úlcera oral
- febre
Other diagnostic factors
- sensação de formigamento
- cefaleia/meningite asséptica
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)
Diagnostic investigations
1st investigations to order
- Reação em cadeia da polimerase do HSV
- cultura viral
Investigations to consider
- Testes sorológicos tipos-específicos para glicoproteína G (gG1 e gG2)
Treatment algorithm
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
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
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.
Differentials
- Sífilis
- Cancroide
- Linfogranuloma venéreo
More DifferentialsGuidelines
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- BASHH summary guidance on testing for sexually transmitted infections, 2023
More GuidelinesPatient information
Herpes genital
Herpes labial
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