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Dermatology845 papers

Herpes simplex

Last edited: 4/14/2026

Overview

Herpes simplex virus (HSV) infections encompass a range of clinical presentations from mild oral or genital lesions to severe central nervous system (CNS) complications, particularly in immunocompromised individuals and neonates. Prompt diagnosis and treatment with antiviral agents are crucial to mitigate morbidity and mortality 1235222632.

Diagnosis

  • Clinical Presentation: Vesicular lesions, often painful, localized to mucosa or skin; may include systemic symptoms in severe cases 1351026.
  • Laboratory Tests: Viral culture, PCR for HSV DNA, Tzanck smear (with caution in interpretation accuracy) 3727.
  • Imaging: MRI or CT scans for CNS involvement to assess for encephalitis or meningitis 126.
  • Serology: Useful for confirming primary vs recurrent infections, particularly in atypical presentations 216.

    • Management

  • First-Line Treatment:
    • - Acyclovir: Oral or intravenous, dose varies by indication (e.g., 5 mg/kg q8h for encephalitis 123). - Valacyclovir: Oral, dose adjusted for severity (e.g., 1 g tid for genital herpes 2). - Famciclovir: Oral, dose adjusted for severity (e.g., 250 mg tid for genital herpes 2).
  • Adjunctive Measures: Supportive care including hydration, pain management, and monitoring for complications like secondary infections 1223.

    • Special Populations

  • Pregnancy:
    • - Routine serologic screening recommended for pregnant women with history of genital herpes 1619. - Antiviral prophylaxis (acyclovir) recommended for third trimester in women with recurrent HSV-2 16.
  • Neonates:
    • - High suspicion and prompt empirical antiviral therapy (acyclovir) in suspected neonatal HSV infection 1213.
  • Elderly and Immunocompromised:
    • - Increased vigilance for disseminated or CNS involvement; prolonged antiviral therapy may be necessary 1526.

    Key Recommendations

  • Initiate prompt antiviral therapy (acyclovir) for suspected HSV CNS infections to improve outcomes 1 (Evidence: Strong).
  • Perform serologic screening for HSV in pregnant women with a history of genital herpes to prevent neonatal transmission 16 (Evidence: Moderate).
  • Consider empirical acyclovir therapy in neonates with suspected HSV infection due to high morbidity and mortality risks 1213 (Evidence: Moderate).
  • Monitor immunocompromised patients closely for disseminated HSV infections requiring extended antiviral treatment 5 (Evidence: Moderate).
  • Use caution in interpreting Tzanck smears for HSV diagnosis due to potential inaccuracies in dermatologist interpretation 27 (Evidence: Weak).

    • References

    1 Grzonka P, Mosimann T, Berger S, Amacher SA, Baumann SM, Gebhard CE et al.. Unveiling the clinical spectrum of herpes simplex virus CNS infections in adults: a systematic review. Systematic reviews 2025. link 2 . Management of Genital Herpes in Pregnancy: ACOG Practice Bulletinacog Practice Bulletin, Number 220. Obstetrics and gynecology 2020. link 3 Huang CW, Hsieh CH, Lin MR, Huang YC. Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children. BMC infectious diseases 2020. link 4 Labrunie T, Ducastelle S, Domenech C, Ader F, Morfin F, Frobert E. UL23, UL30, and UL5 characterization of HSV1 clinical strains isolated from hematology department patients. Antiviral research 2019. link 5 Kurosawa S, Sekiya N, Fukushima K, Ikeuchi K, Fukuda A, Takahashi H et al.. Unusual manifestation of disseminated herpes simplex virus type 2 infection associated with pharyngotonsilitis, esophagitis, and hemophagocytic lymphohisitocytosis without genital involvement. BMC infectious diseases 2019. link 6 Gittler JK, Mu EW, Orlow SJ. Characterization of Herpes Simplex Virus Infections Seen in the Pediatric Dermatology Office. Pediatric dermatology 2017. link 7 Nesburn AB, BenMohamed L. A Tribute to Professor Steven L. Wechsler (1948-2016): The Man and the Scientist. Current eye research 2017. link 8 Hicks CW, Lum YW, Heller JA. Herpes simplex virus following stab phlebectomy. Phlebology 2017. link 9 Bechtel-Grosch U, Beguelin C, Berezowska S, Dufour JF, Takala J, Schefold JC. Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report. Journal of medical case reports 2016. link 10 Rosain J, Froissart A, Estrangin E, Rozenberg F. Severe acute pharyngotonsillitis due to herpes simplex virus type 2 in a young woman. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 2015. link 11 Borhan WM, Dababo MA, Thompson LD, Saleem M, Pashley N. Acute necrotizing herpetic tonsillitis: a report of two cases. Head and neck pathology 2015. link 12 Benidir A, Lim R, Salvadori M, Sangha G, Poonai N. Current practice patterns regarding diagnostic investigations and empiric use of acyclovir by Canadian pediatric emergency physicians in febrile neonates. Pediatric emergency care 2013. link 13 Kenny K, Leung W, Stephanson K, Ross S. Clinical practice in prevention of neonatal HSV infection: a survey of obstetrical care providers in Alberta. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2013. link31017-3) 14 Wilson SS, Fakioglu E, Herold BC. Novel approaches in fighting herpes simplex virus infections. Expert review of anti-infective therapy 2009. link 15 Moriarty AT, Darragh TM, Souers R, Fatheree LA, Wilbur DC. Performance of herpes simplex challenges in proficiency testing: observations from the College of American Pathologists proficiency testing program. Archives of pathology & laboratory medicine 2009. link 16 Money D, Steben M. Guidelines for the management of herpes simplex virus in pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2008. link32868-7) 17 Swearingen JA, Ailor SK. Herpes simplex virus: it's more than a cold sore. Missouri medicine 2007. link 18 Rao G, Chalam KV, Prasad GP, Sarnathan M, Kumar H. Mini outbreak of Kaposi's varicelliform eruption in skin ward: a study of five cases. Indian journal of dermatology, venereology and leprology 2007. link 19 Gardella C, Barnes J, Magaret AS, Richards J, Drolette L, Wald A. Prenatal herpes simplex virus serologic screening beliefs and practices among obstetricians. Obstetrics and gynecology 2007. link 20 Yazici AC, Baz K, Ikizoglu G. Recurrent herpes labialis during isotretinoin therapy: is there a role for photosensitivity?. Journal of the European Academy of Dermatology and Venereology : JEADV 2006. link 21 Stetson CL, Butler DF, Rapini RP. Herpetic whitlow during isotretinoin therapy. International journal of dermatology 2003. link 22 Bielan B. Herpes simplex. Dermatology nursing 2001. link 23 Rajan GR, Cobb JP, Reiss CK. Acyclovir induced coma in the intensive care unit. Anaesthesia and intensive care 2000. link 24 Gutierrez KM, Falkovitz Halpern MS, Maldonado Y, Arvin AM. The epidemiology of neonatal herpes simplex virus infections in California from 1985 to 1995. The Journal of infectious diseases 1999. link 25 Lasner TM, Tal-Singer R, Kesari S, Lee VM, Trojanowski JQ, Fraser NW. Toxicity and neuronal infection of a HSV-1 ICP34.5 mutant in nude mice. Journal of neurovirology 1998. link 26 Wat PJ, Strickler JG, Myers JL, Nordstrom MR. Herpes simplex infection causing acute necrotizing tonsillitis. Mayo Clinic proceedings 1994. link61067-2) 27 Grossman MC, Silvers DN. The Tzanck smear: can dermatologists accurately interpret it?. Journal of the American Academy of Dermatology 1992. link70207-v) 28 Bergström T, Svennerholm B, Conradi N, Horal P, Vahlne A. Discrimination of herpes simplex virus types 1 and 2 cerebral infections in a rat model. Acta neuropathologica 1991. link 29 Hollabaugh ES, Wagner RF, Weedn VW, Smith EB. Patient personal injury litigation against dermatology residency programs in the United States, 1964-1988. Implications for future risk-management programs in dermatology and dermatologic surgery. Archives of dermatology 1990. link 30 Gang RK. Herpes of a digit. Journal of hand surgery (Edinburgh, Scotland) 1989. link 31 Georgsson G, Martin JR, Stoner GL, Webster HF. Virus spread and initial pathological changes in the nervous system in genital herpes simplex virus type 2 infection in mice. A correlative immunohistochemical, light and electron microscopic study. Acta neuropathologica 1987. link 32 Barnes DW, Whitley RJ. CNS diseases associated with varicella zoster virus and herpes simplex virus infection. Pathogenesis and current therapy. Neurologic clinics 1986. link 33 Cavagnolo RZ. Inactivation of herpesvirus on CPR manikins utilizing a currently recommended disinfecting procedure. Infection control : IC 1985. link 34 Geboes K, Rutgeerts P, Stessens L, Vantrappen G, Desmet V. Expression of MHC Class II antigens by oesophageal epithelium in herpes simplex oesophagitis. Histopathology 1985. link 35 Kumarasamy R, Blough HA. Galactose-rich glycoproteins are on the cell surface of herpes virus-infected cells. 1. Surface labeling and serial lectin binding studies of Asn-linked oligosaccharides of glycoprotein gC. Archives of biochemistry and biophysics 1985. link90663-0) 36 Lehtinen M. Immunoblotting and ELISA analysis of HSV-1 and HSV-2-specified polypeptides by using an immunoblocking method. Annals of clinical research 1985. link 37 Greenhouse PR, Thin RN. Framboesiform lesions in primary herpes simplex infection: a case report. The British journal of venereal diseases 1984. link 38 Ludwig IH, Zegarra H, Zakov ZN. The acute retinal necrosis syndrome. Possible herpes simplex retinitis. Ophthalmology 1984. link34109-4) 39 Anolik R, Kolski GB, Schaible DH, Ratner J. Transient alteration of theophylline half-life: possible association with Herpes simplex infection. Annals of allergy 1982. link 40 Scriba M. Animal studies on the efficacy of vaccination against recurrent herpes. Medical microbiology and immunology 1982. link 41 Shelley WB. Herpetic arthritis associated with disseminate herpes simplex in a wrestler. The British journal of dermatology 1980. link 42 Palmer EL, Martin ML, Warfield DT. Preparation of type 2 herpes simplex virus complement-fixing antigen. Applied microbiology 1971. link

    Original source

    1. [1]
      Unveiling the clinical spectrum of herpes simplex virus CNS infections in adults: a systematic review. — Grzonka P, Mosimann T, Berger S, Amacher SA, Baumann SM, Gebhard CE et al. Systematic reviews (2025)
    2. [2]
      Management of Genital Herpes in Pregnancy: ACOG Practice Bulletinacog Practice Bulletin, Number 220. Obstetrics and gynecology (2020)
    3. [3]
      Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children. — Huang CW, Hsieh CH, Lin MR, Huang YC BMC infectious diseases (2020)
    4. [4]
      UL23, UL30, and UL5 characterization of HSV1 clinical strains isolated from hematology department patients. — Labrunie T, Ducastelle S, Domenech C, Ader F, Morfin F, Frobert E Antiviral research (2019)
    5. [5]
      Unusual manifestation of disseminated herpes simplex virus type 2 infection associated with pharyngotonsilitis, esophagitis, and hemophagocytic lymphohisitocytosis without genital involvement. — Kurosawa S, Sekiya N, Fukushima K, Ikeuchi K, Fukuda A, Takahashi H et al. BMC infectious diseases (2019)
    6. [6]
      Characterization of Herpes Simplex Virus Infections Seen in the Pediatric Dermatology Office. — Gittler JK, Mu EW, Orlow SJ Pediatric dermatology (2017)
    7. [7]
      A Tribute to Professor Steven L. Wechsler (1948-2016): The Man and the Scientist. — Nesburn AB, BenMohamed L Current eye research (2017)
    8. [8]
      Herpes simplex virus following stab phlebectomy. — Hicks CW, Lum YW, Heller JA Phlebology (2017)
    9. [9]
      Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report. — Bechtel-Grosch U, Beguelin C, Berezowska S, Dufour JF, Takala J, Schefold JC Journal of medical case reports (2016)
    10. [10]
      Severe acute pharyngotonsillitis due to herpes simplex virus type 2 in a young woman. — Rosain J, Froissart A, Estrangin E, Rozenberg F Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (2015)
    11. [11]
      Acute necrotizing herpetic tonsillitis: a report of two cases. — Borhan WM, Dababo MA, Thompson LD, Saleem M, Pashley N Head and neck pathology (2015)
    12. [12]
      Current practice patterns regarding diagnostic investigations and empiric use of acyclovir by Canadian pediatric emergency physicians in febrile neonates. — Benidir A, Lim R, Salvadori M, Sangha G, Poonai N Pediatric emergency care (2013)
    13. [13]
      Clinical practice in prevention of neonatal HSV infection: a survey of obstetrical care providers in Alberta. — Kenny K, Leung W, Stephanson K, Ross S Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC (2013)
    14. [14]
      Novel approaches in fighting herpes simplex virus infections. — Wilson SS, Fakioglu E, Herold BC Expert review of anti-infective therapy (2009)
    15. [15]
      Performance of herpes simplex challenges in proficiency testing: observations from the College of American Pathologists proficiency testing program. — Moriarty AT, Darragh TM, Souers R, Fatheree LA, Wilbur DC Archives of pathology & laboratory medicine (2009)
    16. [16]
      Guidelines for the management of herpes simplex virus in pregnancy. — Money D, Steben M Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC (2008)
    17. [17]
      Herpes simplex virus: it's more than a cold sore. — Swearingen JA, Ailor SK Missouri medicine (2007)
    18. [18]
      Mini outbreak of Kaposi's varicelliform eruption in skin ward: a study of five cases. — Rao G, Chalam KV, Prasad GP, Sarnathan M, Kumar H Indian journal of dermatology, venereology and leprology (2007)
    19. [19]
      Prenatal herpes simplex virus serologic screening beliefs and practices among obstetricians. — Gardella C, Barnes J, Magaret AS, Richards J, Drolette L, Wald A Obstetrics and gynecology (2007)
    20. [20]
      Recurrent herpes labialis during isotretinoin therapy: is there a role for photosensitivity? — Yazici AC, Baz K, Ikizoglu G Journal of the European Academy of Dermatology and Venereology : JEADV (2006)
    21. [21]
      Herpetic whitlow during isotretinoin therapy. — Stetson CL, Butler DF, Rapini RP International journal of dermatology (2003)
    22. [22]
      Herpes simplex. — Bielan B Dermatology nursing (2001)
    23. [23]
      Acyclovir induced coma in the intensive care unit. — Rajan GR, Cobb JP, Reiss CK Anaesthesia and intensive care (2000)
    24. [24]
      The epidemiology of neonatal herpes simplex virus infections in California from 1985 to 1995. — Gutierrez KM, Falkovitz Halpern MS, Maldonado Y, Arvin AM The Journal of infectious diseases (1999)
    25. [25]
      Toxicity and neuronal infection of a HSV-1 ICP34.5 mutant in nude mice. — Lasner TM, Tal-Singer R, Kesari S, Lee VM, Trojanowski JQ, Fraser NW Journal of neurovirology (1998)
    26. [26]
      Herpes simplex infection causing acute necrotizing tonsillitis. — Wat PJ, Strickler JG, Myers JL, Nordstrom MR Mayo Clinic proceedings (1994)
    27. [27]
      The Tzanck smear: can dermatologists accurately interpret it? — Grossman MC, Silvers DN Journal of the American Academy of Dermatology (1992)
    28. [28]
      Discrimination of herpes simplex virus types 1 and 2 cerebral infections in a rat model. — Bergström T, Svennerholm B, Conradi N, Horal P, Vahlne A Acta neuropathologica (1991)
    29. [29]
      Patient personal injury litigation against dermatology residency programs in the United States, 1964-1988. Implications for future risk-management programs in dermatology and dermatologic surgery. — Hollabaugh ES, Wagner RF, Weedn VW, Smith EB Archives of dermatology (1990)
    30. [30]
      Herpes of a digit. — Gang RK Journal of hand surgery (Edinburgh, Scotland) (1989)
    31. [31]
      Virus spread and initial pathological changes in the nervous system in genital herpes simplex virus type 2 infection in mice. A correlative immunohistochemical, light and electron microscopic study. — Georgsson G, Martin JR, Stoner GL, Webster HF Acta neuropathologica (1987)
    32. [32]
      CNS diseases associated with varicella zoster virus and herpes simplex virus infection. Pathogenesis and current therapy. — Barnes DW, Whitley RJ Neurologic clinics (1986)
    33. [33]
      Inactivation of herpesvirus on CPR manikins utilizing a currently recommended disinfecting procedure. — Cavagnolo RZ Infection control : IC (1985)
    34. [34]
      Expression of MHC Class II antigens by oesophageal epithelium in herpes simplex oesophagitis. — Geboes K, Rutgeerts P, Stessens L, Vantrappen G, Desmet V Histopathology (1985)
    35. [35]
      Galactose-rich glycoproteins are on the cell surface of herpes virus-infected cells. 1. Surface labeling and serial lectin binding studies of Asn-linked oligosaccharides of glycoprotein gC. — Kumarasamy R, Blough HA Archives of biochemistry and biophysics (1985)
    36. [36]
      Immunoblotting and ELISA analysis of HSV-1 and HSV-2-specified polypeptides by using an immunoblocking method. — Lehtinen M Annals of clinical research (1985)
    37. [37]
      Framboesiform lesions in primary herpes simplex infection: a case report. — Greenhouse PR, Thin RN The British journal of venereal diseases (1984)
    38. [38]
      The acute retinal necrosis syndrome. Possible herpes simplex retinitis. — Ludwig IH, Zegarra H, Zakov ZN Ophthalmology (1984)
    39. [39]
      Transient alteration of theophylline half-life: possible association with Herpes simplex infection. — Anolik R, Kolski GB, Schaible DH, Ratner J Annals of allergy (1982)
    40. [40]
      Animal studies on the efficacy of vaccination against recurrent herpes. — Scriba M Medical microbiology and immunology (1982)
    41. [41]
      Herpetic arthritis associated with disseminate herpes simplex in a wrestler. — Shelley WB The British journal of dermatology (1980)
    42. [42]
      Preparation of type 2 herpes simplex virus complement-fixing antigen. — Palmer EL, Martin ML, Warfield DT Applied microbiology (1971)
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