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  Herpes simplex viruses 1 and 2 

Herpes simplex viruses (HSVs) are enveloped, linear, double-stranded DNA viruses, whose only hosts are humans. There are two types, 1 and 2. They have different clinical manifestations and different epidemiologies. Aciclovir, valaciclovir, and famciclovir are antivirals used in treatment.

Epidemiology of Herpes simplex viruses 1 and 2 

Herpes labialis (caused by HSV-1) and herpes genitalis (caused by HSV-2) are the most common HSV-induced diseases. More than 85% of the world’s population is seropositive for HSV-1. The incidence of HSV-1 is influenced by socio-economic status, geographic location, and age.

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Herpes genitalis is one of the most common sexually transmitted diseases in the world. Seroconversion for HSV-2 rarely occurs before the onset of sexual activity. The strongest predictor for HSV-2 infection is the lifetime number of sexual partners. Seroprevalence is higher among women than men.

Transmission of Herpes simplex viruses 1 and 2 

Herpes simplex viruses are transmitted during personal contact through the exchange of saliva, semen, cervical fluid, or vesicle fluid from active lesions. The virus must contact mucosal surfaces or abraded skin.

Co-infection with HSV and HIV frequently occurs, probably because they potentiate each other’s transmission. 

Clinical manifestations of Herpes simplex viruses 1 and 2 

A prodrome may occur, characterized by localized pain, tingling, burning, tenderness, paraesthesiae, lymphadenopathy, headache, fever, anorexia, or malaise.

With disease progression, papules, vesicles on an erythematous base, and erosions may appear over hours to days. The lesions crust, then re-epithelialize, healing without scarring within 7–10 days. Other presentations include oedema, fissures, ulcers, and pustules. Cystitis, meningitis, urethritis, or cervicitis may be the presenting condition in some cases. 

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Herpes labialis (HSV-1)

Affects the buccal and gingival mucosa during primary infection. Termed gingivostomatitis, it is a common presentation in children. Lesions frequently appear at the vermilion border of the lip and consist of 3 to 5 vesicles that often become pustular, ulcerative, or crusted within 72 to 96 hours. The pain resolves quickly afterwards. During an episode, there may be difficulty swallowing due to oedema of the oropharynx. Most patients have approximately two outbreaks per year. Topical antivirals are effective. Oral aciclovir for herpes labialis has mixed therapeutic value. 

Herpetic whitlow

This is an infection of the distal phalanx, caused by HSV-1 (more commonly) or HSV-2, and characterized by pain, tingling, burning, swelling, erythema, and vesicles on an erythematous base. 

Herpes gladitorium (HSV-1)

Athletes involved in contact sports, such as wrestling, may develop HSV-1 infection of the head or eye. The trunk or extremities may also be involved. 

HSV folliculitis

A viral folliculitis of the beard (herpes sycosis) or other parts of the body present as painful, grouped, erythematous, perifollicular vesicles.

HSV keratoconjunctivitis

This is the commonest cause of corneal blindness in the USA. 

Herpes genitalis (HSV-2)

This disease is sexually transmitted and is caused by HSV-2. In women, lesions may involve the vulva, cervix, vagina, or perianal skin and extra-genital areas, such as buttocks, thighs, or perineum. Women have more severe diseases and higher complication rates from primary infection than men. Inguinal adenopathy, dysuria, and retention may result. 

Men develop vesicles (often 6–10) most commonly on the glans penis or penile shaft. Perianal infection with proctitis is more common in homosexual men, and extra-genital disease may occur.

Oral aciclovir is effective when started within 24 hours of lesion formation, shortening the viral shedding and hastening lesion healing. Aciclovir is also used for the treatment of recurrent genital herpes. Valaciclovir is as effective as aciclovir for recurrences. 

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Neonatal herpes

Neonatal herpes simplex infections can have devastating consequences. Infection can range from the involvement of the skin, eyes, mouth, as well as encephalitis or disseminated disease.

Herpes simplex virus in the immunocompromised

This group of patients develop more severe HSV infections. Recurrent outbreaks occur with greater frequency, and lesions may be extensive or persistent. 

Investigations of Herpes simplex viruses 1 and 2 

The gold standard for diagnosis is viral culture. An adequate sample requires vigorous swabbing of the base of the lesions. A rapid diagnostic method involves unroofing the vesicle, scraping the base of the lesion, and examining the sample under the microscope, using the Tzanck smear technique.