Herpes Simplex Virus (HSV)

Sites

  • Skin, in particular around genitalia, mouth, peri-rectal/sigmoid colon
  • Can affect solid organs like lung--> cough/sob, liver--> RUQ pain
  • Also brain, meninges, nerves and disseminated

Etiology

  • HSV1 tends to occur around mouth
  • HSV2 tends to occur in genital and rectal areas
  • Though HSV1 and 2 can occur at either site

Risk Factors

  • Spread through direct muco-cutaneous contact: kissing, wrestling, sexual, other close contact --> oral area; sexual contact --> genital, peri-rectal
  • More severe, higher rates of recurrence and longer duration withHIV/low CD4 or other compromised states

Symptoms

  • Neuropathic tingling/burning pain can precede appearance of vesicles and then ulcers (worse if immunocomp); most commonly in genital, oral and rectal areas
  • Rectal pain, bleeding, tenesmus if higher up rectal canal (proctitis)
  • Numbness; less commonly weakness of involved nerves
  • Regress spontaneously 1-3w
  • Can be primary infection (first occurrence)-->presents w/in 1w of exposure
  • HSV2 recurs in 70-90%
  • HSV assoc w/Bell's palsy and lumbro-sacral radiculitis
  • Headche and confusion with brain involvement
  • Can sometimes precipitate erythema multiforme

Physical Exam Findings

  • Clear vesicles on red base, w/small ulcers developing after uncovered; oral, genital, rectal areas
  • Can have regional adenopathy
  • Hyperalgesia, numbness; rarely weakness

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