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