Snapshot
- A 22-year-old man presents to an urgent care clinic for a severe painful genital ulcer. His symptoms are associated with fever, headache, myalgias, and dysuria. He has a medical history of asthma. Social history is significant for having multiple recent sexual partners while not using condoms. Physical examination is significant for a genital ulcer with associated tender inguinal lymphadenopathy. A polymerase chain reaction returns positive for HSV2 infection.
Introduction
- Classification
- an enveloped, linear, double-stranded DNA virus from the Herpesviridae family
- Epidemiology
- incidence
- most cases of recurrent genital herpes are caused by HSV2
- incidence
- Transmission
- sexual contact
- perinatal
- Pathogenesis
- HSV2 inoculates in the mucous membrane or skin after close contact with the skin or genital secretions of a patient with viral shedding
- cytolytic replication occurs in the epithelial cells where the virus enters, which then travels to the sensory dorsal root ganglia, where it lies dormant
- HSV2 inoculates in the mucous membrane or skin after close contact with the skin or genital secretions of a patient with viral shedding
- Prognosis
- immunocompromised patients have more severe herpetic episodes with frequent viral reactivation
Presentation
Studies
- Making the diagnosis
- based on the patient’s history and physical exam, which is confirmed by laboratory testing
- Confirmatory testing includes
- viral culture
- polymerase chain reaction (PCR)
- direct fluorescence antibody
- serological testing
- Tzank smear
- demonstrates multinucleated giant cells (intranuclear eosinophilic Cowdry A inclusions)
- seen in HSV1, HSV2, and VZV infections
Differential
- Chancre
- differentiating factor
- abnormal VDRL and RPR testing
Treatment
- Medical
- patients with frequent outbreaks
Complications
- Neonatal herpes
- Disseminated vesicular rash