Herpes Simplex

Basics

Viral disease characterized by recurrent, self-limited, painful vesicular lesions of mucocutaneous areas
Leads to genital infections as well as orolabial, skin, ocular, and CNS manifestations
Severe complications include encephalitis, neonatal herpes, and fatal dissemination especially in immunocompromised hosts
Caused by herpes simplex type-1 (HSV-1) or type 2 (HSV-2)
Infection is characterized by 2 phases:
- Primary – virus established in a nerve ganglion which is often asymptomatic
- Nonprimary – acquisition of HSV by person already infected with other subtype
- Secondary – latent infection in patient with preexisting immunity
Worldwide, HSV-1 has 50–80% seroprevalence and HSV-2 10–15%, higher in women and non-Hispanic African American populations
HSV-2 infections increase susceptibility to HIV infection
HSV reactivation associated with nearly 80% of recurrent erythema multiforme cases
HSV-1 is one of the most common viral causes of encephalitis in the US:
- Untreated infection with mortality rate >70%

HSV-1 and HSV-2 are DNA viruses of the Herpesviridae family
Establishes latency in neural ganglia after primary infection and reactivates to cause recurrent infection or subclinical viral shedding
Both HSV-1 and HSV-2 transmitted through intimate contact of skin and mucosal surfaces:
- HSV-1 typically transmitted by oral secretions and nonsexual contact and involves oral, pharyngeal, facial, ocular, and CNS infections
- HSV-2 typically involves anogenital tract and transmitted mainly through sexual contact
Incubation period is ∼4–10 d from exposure
Viral shedding occurs from 7–12 d (up to 23 d) in primary infection and 3–4 d in recurrent infections

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