Recurrent Herpes Simplex Infections

1. Recurrent Herpes Labialis

The most common type of herpes simplex infection is recurrent herpes labialis. Subjective symptom is pruritus. Grouped vesicles appearing on erythematous and edematous base follow it. Vesicles may transform to pustules. Erosions occur after opening the vesicles and pustules, and crusts occur after drying these lesions. Crusts cover the erosions, and finally crust falls and recurrence ends.

2. Recurrent Herpes Genitalis

Itching is the first symptom and on the entrance area vesicles follow it. They are opened and crusts rarely occur. Causative agent is mainly type 2 HSV. Formerly this virus is considered as a carcinogen in women. But real carcinogen virus is Human papilloma virus (HPV) that infects frequently the women together with type 2 HSV. Herpes genitalis is a sexually transmitted disease. Neonate is contaminated by HSV even pregnant do not have genital lesion, so Cesarean indication should be considered.

Differential diagnosis must be made by syphilis if the patient has erosion in the genital area. Borders of the erosions are intended in herpes genitalis. Chancre of syphilis is based on a papule, so the base of chancre is firm and patient has not any subjective complaint, but pruritus in herpes genitalis. Chancre is shined, but not wet like herpes genitalis. Patient has bilateral lymphadenopathy in syphilis, but not in herpes genitalis unless secondary infection. Non-specific syphilis serological tests may be false positive in secondary infected herpes genitalis. Specific tests or identification of Treponema pallidum must be done for definitive diagnosis.

3. Recurrent Herpetic Keratoconjunctivitis

Clinical features are the same as primary herpetic keratoconjunctivitis.

4. Recurrent Lumbosacral Herpes

Itchy vesicle groups on lumbosacral area are seen as herpes labialis or genitalis.

5. Meningitis / Encephalitis

These are rarely seen.

Treatment

There is not any treatment to eradicate the virus. Clinical manifestations only quickly improve with acyclovir or its derivates. Acyclovir is used as locally in recurrent types and systemically in primary types mainly. But derivates are only used systemically.


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