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Herpes simplex virus

Herpes simplex virus

There are two strains of the herpes simplex virus (HSV) in humans: HSV-1 and HSV-2. Whilst it was previously thought HSV-1 accounted for oral lesions (cold sores) and HSV-2 for genital herpes it is now known there is considerable overlap

Features
  • primary infection:
    • severe gingivostomatitis
    • cervical lymphadenopathy
    • fever
  • recurrent infection:
    • cold sores
    • painful genital ulceration

Management
  • gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
  • cold sores: topical aciclovir although the evidence base for this is modest
  • genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir

Pregnancy
  • elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
  • women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low

Pap smear. Multinucleated giant cells representing infection by the herpes simplex virus. Note the 3 M's; Multinucleation, Margination of the chromatin, Molding of the nuclei

Further Pap smear showing the cytopathic effect of HSV (multi-nucleation, ground glass & marginated chromatin)
+PassMedicine Notes

There are two strains of the herpes simplex virus (HSV) in humans: HSV-1 and HSV-2. Whilst it was previously thought HSV-1 accounted for oral lesions (cold sores) and HSV-2 for genital herpes it is now known there is considerable overlap

Features
  • primary infection:
    • severe gingivostomatitis
    • cervical lymphadenopathy
    • fever
  • recurrent infection:
    • cold sores
    • painful genital ulceration
Management
  • gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
  • cold sores: topical aciclovir although the evidence base for this is modest
  • genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir
Pregnancy
  • elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
  • women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
usb007.jpg# Pap smear. Multinucleated giant cells representing infection by the herpes simplex virus. Note the 3 M's; Multinucleation, Margination of the chromatin, Molding of the nuclei uwb051.jpg#http://en.wikipedia.org/wiki/Herpes simplex virus Further Pap smear showing the cytopathic effect of HSV (multi-nucleation, ground glass & marginated chromatin)

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