Herpes Simplex Virus Infection

Herpes simplex virus infections occur equally between the sexes throughout the year. 

HSV-1 transmission typically occurs via oral-oral, oral-genital, or genital-genital contact.

HSV-2 lesions largely involve the genital tract, with the virus remaining latent in the sacral nerve root ganglia (S2–S5) 

Symptoms & Signs 

Both viral subtypes can cause genital and oral–facial infections

The infections caused by the two subtypes are clinically indistinguishable.

Gingivostomatitis and pharyngitis:   the most frequent clinical manifestations of primary HSV-1 infection; presents as small, grouped vesicles on an erythematous base, burning and stinging sensation, swollen and tender burning and stinging 

Genital: most genital infections are caused by HSV-2; presents with bilateral genital ulcerations and tender lymphadenopathy. 

Ocular disease: HSV keratitis presents with vision loss, pain, and discharge; it is a major cause of blindness from corneal scarring and opacity. 

Neonatal & Congenital infection: Neonatal HSV can present as excessive tearing, eye pain, conjunctival edema, vesicular lesions of the mouth, palate, tongue, seizures, irritability, fever, multiple organ failure

CNS Disease: Both viruses can cause encephalitis; the temporal lobe is often involved; it presents with 

the rapid onset of fever, headache, seizures, focal neurologic signs, and impaired consciousness

Bell’s Palsy: HSV-1 is a cause of Bell palsy (facial nerve paralysis)

Esophagitis & Proctitis: usually presents with dysphagia or odynophagia, fever, retrosternal chest pain 

Erythema multiforme: HSV infection is the most common cause of EM; Cutaneous eruptions occur 2 to 7 days after herpes simplex infection 


Diagnosis can be made by physical examination; Direct fluorescent antibody slide tests, viral culture, polymerase chain reaction 


Early antiviral therapy within 72 hours of symptom onset

Antiviral drugs: Acyclovir, Famciclovir, Valacyclovir 

Severe or frequent recurrences: Chronic suppressive therapy with antivirals 

Keratitis: The usage of topical corticosteroids may exacerbate the infection


Male circumcision is associated with a lower incidence of acquiring HSV-2 infection.


  1. What is the most frequent sign of HSV reactivation disease? Herpes labialis 
  2. What is the most frequent etiologic agent of Erythema multiforme? Herpes simplex virus 
  3. What is the most common cause of fatal sporadic encephalitis in the United States? HSV-1 encephalitis 

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