Herpes Simplex

Bing-rong ZHOU
The 1st Affiliated Hospital of
Nanjing Medical University
 Key concepts

• The hallmarks of herpes

simplex are clusters of
painful inflamed papules
and vesicles, most
commonly seen on the
skin and mucosa junction,
tend to recurrence.
 ETIOLOGY
Caused by Herpes Simplex Virus (HSV)
There are 2 types :

• HSV-1, also called Human Herpes Virus 1 (HHV-1)

• HSV-2, also called Human Herpes Virus 2 (HHV-2)

 ETIOLOGY - HSV

• HSV-1 is mostly responsible

for herpes labialis and
herpetic gingivostomatitis.
 ETIOLOGY - HSV

• HSV-2 is usually associated

with herpes genitalis.
 ETIOLOGY

• HSV enters through small defects in skin or

mucosa and starts to replicate locally
• Then ascends via axons to sensory ganglia
where further replication occurs.
• After primary infection, HSV becomes latent
in the sensory ganglia.
 ETIOLOGY
• Latent virus could be reactivated by :
– Physical trauma
– UV light
– Fever
– Systemic infection
– Local or systemic immunosuppression
Leads to spreading of the virus into area
innervated by the sensory ganglia, thus to the
recurrent herpetic lesion.
 Clinical Features

• Primary infection with HSV is often

asymptomatic, but more severe than that
in recurrences.
• Incubation period : 6-8 days.
 Clinical Features
• Usually preceded by a day or two of local
prodrome of discomfort.
• Erythematous macules or patches with
clusters of small blisters.
• Blisters develop into superficial ulcers with
crusts.
• Lesions are accompanied by severe pain
and tender lymphadenopathy.
 Clinical Features

• Most lesions heal within 1 to 2 weeks

without scarring.
• High fever and pustules may indicate
bacterial infections.
 Diagnosis and Differential
Diagnosis

• Diagnosis is made mainly based on the

typical clinical presentations.

• Important differential diagnosis :

– Herpes Zoster
– Chickenpox
– Impetigo
 Differential Diagnosis

Herpes Simplex Herpes Zoster

Lesion can be solitary or Clusters in zonal distribution
multiple
The vesicles tend to be more The vesicles may coalesce,
uniform in size thus forming different sizes
Most commonly on skin and Most commonly on trunk
mucosa junction such as
perioral region
Much less painful Significant neuralgia
Apt to recurrence Seldom to recur
Differential Diagnosis

Herpes Zoster
 Differential Diagnosis

Herpes Simplex Chickenpox

Lesion can be solitary or Eruption typically begins on the
multiple in cluster, not face, scalp, and trunk, then
widespread spreads to involve the
extremities
Most commonly on skin and All over the body
mucosa junction such as
perioral region
Constitutional symptoms are Rash is frequently preceded by
not significant 2-3 days of fever and flulike
symptoms, which often persist
Painful Pruritic
Apt to recurrence Generally once
Differential Diagnosis

Chickenpox
 Differential Diagnosis

Herpes Simplex Impetigo

Mostly in adults Mostly in children
Vesicles with Vesicles with
clear fluid purulent pus
Most commonly on skin and Most commonly on face and
mucosa junction such as lower legs
perioral region
Negative bacterial culture Positive bacterial culture of
Staphylococcus aureus /
Streptococcus hemolyticus
Apt to recurrence Seldom to recur
Differential Diagnosis

Impetigo
 Treatments
• Antiviral Therapy

• General Measures
 Treatments – Antiviral Therapy
• For primary infection :

– Acyclovir 200 mg 5 times daily or

– Famciclovir 250 mg 3 times daily or
– Valaciclovir 500 mg 2 times daily

orally for 7 to 10 days.

 Treatments – Antiviral Therapy
• For recurrences :

– Acyclovir 200 mg 5 times daily or

– Famciclovir 250 mg 3 times daily or
– Valaciclovir 500 mg 2 times daily

orally for 5 days.

 Treatments – Antiviral Therapy
• For patients who have frequent
recurrences (>6 times a year) :

– Acyclovir 400 mg 2 times daily

 Treatments – General
Measures
• Cleansing mouthwashes with
Benzalkonium bromide 1:1000
– To clean the involved mucous membranes.

• Topical antibacterial such as mupirocin

or povidone-iodine ointment to prevent
bacterial superinfection.
 END
• What is the clinical appearances of Herpes
Simplex?