Herpes simplex virus infection

Case history #1

A 24-year-old woman presents with a 3-day history of painful sores in the genital area, dysuria, fever, and headache. She is sexually active with men and has a new partner within the past month. She does not use condoms. Physical examination reveals a temperature of 38.3°C (100.9°F), stable vital signs, slight nuchal rigidity (implying aseptic meningitis), bilateral tender inguinal lymphadenopathy, and multiple tender 1- to 2-cm erythematous ulcerations without labial crusts. The cervix is oedematous with pustules and clear discharge. Cervical motion tenderness is also present.

Case history #2

A 25-year-old man presents for STI screening. He is sexually active with men, has had four partners in the past year, and uses condoms 'most of the time'. He was HIV-negative 6 months ago and denies a history of urethral discharge, dysuria, or genital ulcers. He does have occasional genital itching and mild sores on the penile shaft. Genitourinary examination reveals a circumcised male with no inguinal lymphadenopathy, no lesions on the penile shaft or perianal area, and no urethral discharge.

Other presentations

Genital herpes cannot be reliably differentiated on a clinical basis from other causes of genital ulcer disease. Proctitis or cervicitis can often result from a wide spectrum of manifestations involving the perineal, perianal, and rectal mucosa. Tingling and dysaesthesias may be prodromal symptoms of a recurrence.

Herpes labialis classically presents with recurrent ulceration along the vermillion border of the lip but may also present with pharyngitis. Other manifestations include herpetic whitlow and herpes gladiatorum, which present with vesicular lesions and ulcerations on fingers or at sites of trauma, respectively.

Immunocompromised patients may have more severe, prolonged ulceration of the genital or oral mucosa than immunocompetent patients.

Other presentations of visceral or disseminated HSV infection, including hepatitis, pneumonitis, or central nervous system disease, may occur as primary or recurrent infections. See Complications.