Herpes simplex virus type 2 pathophysiology

Acute retinal necrosis - presents with a unilateral or bilateral red eye s , periorbital pain, and impaired visual acuity. Examination reveals episcleritis or scleritis and necrosis with retinal detachment. May occur with HSV-2 meningoencephalitis. Deterrence and Patient Education Condom use recommended. Consider prophylactic suppressive therapy if frequent sexual activity is likely to occur [23]. Pearls and Other Issues HSV cannot be cured, but suppressive therapy can help prevent spread to seronegative individuals.

Enhancing Healthcare Team Outcomes The primary care physician or provider will often be the first one to diagnose and treat HSV-2 infections. The interprofessional healthcare team, to include the medical assistants and nursing staff, are pivotal in providing medical education to the patient on how to prevent unnecessary spread.

This should be documented and communicated to the treating physician. Utilizing network public health officials can help dispense information as well as track STIs in the area leading to early identification in patients who may be otherwise asymptomatic. Pharmacists review medications, verify dosing, check for interactions, inform patients about use and potential side effects.

They also may be involved in the purchase of condoms and can make patient recommendations. Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Herpes Simplex. Contributed by DermNetNZ.

Figure This was an outbreak of herpes genitalis, which had manifested as blistering on the underside of the penile shaft, just proximal to the corona of the glans, which was due to the herpes simplex 2 HSV-2 virus, otherwise referred to as genital herpes. References 1. Sexually transmitted diseases treatment guidelines, Whitley R, Baines J.

Clinical management of herpes simplex virus infections: past, present, and future. Sauerbrei A. Herpes Genitalis: Diagnosis, Treatment and Prevention. Geburtshilfe Frauenheilkd. Herpes virus type 2 infection and genital symptoms in primary care patients. Sex Transm Dis. Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention.

Virol J. Seroprevalence of herpes simplex virus types 1 and United States, J Infect Dis. Seroprevalence of herpes simplex virus type 2 among persons aged years--United States, Berger JR, Houff S. Neurological complications of herpes simplex virus type 2 infection. Arch Neurol. Fatahzadeh M, Schwartz RA.

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. Am J Surg Pathol. Herpes folliculitis: clinical, histopathological, and molecular pathologic observations.

Br J Dermatol. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. Herpes simplex virus viremia during primary genital infection. The laboratory diagnosis of herpes simplex virus infections. Slomka MJ. Current diagnostic techniques in genital herpes: their role in controlling the epidemic.

Clin Lab. Acta Obstet Gynecol Scand. Clin Ther. Herpes simplex virus type 2: epidemiology and management options in developing countries. Sex Transm Infect. HSV can infect virtually any part of the skin or mucosa. This is referred to as herpetic whitlow and most commonly occurs in medical and dental professionals, in whom it results from digital contamination with genital or oral secretions Feder and Long, The typical clinical course of whitlow involves the initial appearance of discrete vesicular or pustular lesions over the distal phalynx which subsequently coalesce over several days.

Pain often is associated with a tingling or burning sensation. Fever, lymphangitis, and tender swelling of local lymph nodes may be present. The diagnosis of herpetic whitlow is most often confused with bacterial cellulitis.

Close contact between abraded skin and oral secretions results in cutaneous infections caused by HSV-1 among participants in certain contact sports including wrestlers herpes gladiatorum and rugby players scrum-pox Becker et al.

In descending order, the most common sites of infection among wrestlers are the head, extremities, and trunk Belongia et al. Herpes infections also can result in severe cutaneous infection when they occur on skin damaged by diaper dermatitis, burns, or atopic dermatitis Jenson and Shapiro, ; Wheeler and Abele, ; McMill and Cartotto, Finally, HSV is the most common precipitating factor for recurrent erythema multiforme Orton et al. Herpes simplex viruses cause a variety of peripheral and CNS illnesses of infectious and post-infectious nature Simmons, ; Schmutzhard, Encephalitis can result from a primary or, more commonly, a reactivated HSV infection.

Patients typically present with altered state of consciousness, bizarre behavior, and focal neurologic findings, referable to the temporal lobe. Typical findings on electroencephalography include focal spike and slow-wave abnormalities, with characteristic paroxysmal lateralizing epileptiform discharges. Focal edema associated with hemorrhagic necrosis may be present on neurodiagnostic images; abnormalities tend to be evident earlier on magnetic resonance imaging than computed tomography.

Manifestations of congenital infection include skin lesions and scars, chorioretinitis, microcephaly, hydranencephaly, and microphthalmia Hutto et al. Neonates infected perinatally present with a range of manifestations, categorized as localized to the skin eye and mouth SEM or the CNS, or as disseminated infection. Neonates with SEM disease usually present during the first 2 weeks of life; occasionally skin lesions are evident in the delivery room.

The cutaneous lesions first appear where there has been trauma, such as the site of attachment of fetal scalp electrodes, the margin of the eyes, or over the presenting body part. Initially the lesions appear as macules but they rapidly evolve to vesicles. Outcome of SEM disease is excellent if diagnosis is considered, and antiviral therapy administered, in a timely fashion Kimberlin et al.

Neonatal HSV infection involving the CNS usually results in fever and lethargy, first appearing between the second and third weeks of life. The sign most specific for HSV infection is the presence of skin lesions.

However, approximately one-third infants with CNS disease due to HSV infection do not have skin lesions at the time of clinical presentation Kimberlin et al. A common but not as specific sign of neonatal HSV infection of the CNS is the sudden onset of seizures that tend to be focal and difficult to control. The electroencephalogram typically is diffusely abnormal and magnetic resonance imaging reveals either temporal or diffuse cerebral disease.

If untreated, most neonates with CNS infection caused by HSV die and almost all survivors are left severely neurologically impaired. Signs of disseminated infection caused by HSV may mimic severe bacterial infection with onset during the first week of life. Common clinical manifestations include vascular instability, hepatomegaly, jaundice, bleeding, and respiratory dysfunction.

Progression of infection is rapid, with death resulting from shock, liver failure with bleeding, respiratory failure, or neurologic compromise. The likelihood of complicated HSV, with attendant substantial morbidity, parallels the degree of compromise of cellular immune function Rand et al. The most frequent complication of HSV infections among immunocompromised patients is slowly progressive and chronic mucocutaneous infections, accompanied by extensive tissue damage and necrosis Whitley et al.

Contiguous mucosal spread resulting in esophageal, tracheal, pulmonary involvement or visceral dissemination also can occur but fatal infections are not common. Turn recording back on. National Center for Biotechnology Information , U. Cambridge: Cambridge University Press ; Search term. Pathogenesis The transmission of herpes simplex virus HSV infection is dependent upon intimate, personal contact of a susceptible seronegative individual with someone excreting HSV.

Unique biologic properties of HSV that influence pathogenesis HSV-1 and HSV-2 exhibit two unique biologic properties that influence pathogenesis and subsequent human disease. Gross pathologic findings in HSE, illustrating hemorrhagic necrosis of the inferior medial portion of the temporal lobe Whitley, Impact of host response to infection on disease The pathogenesis of HSV infections is influenced by both specific and non-specific host defense mechanisms Lopez et al.

Orolabial infection Primary infection The oropharynx is the most common site of infection caused by HSV Genital infection Primary infection The majority of primary genital herpes infections occur in the absence of symptoms. Keratoconjunctivitis Herpes simplex virus is a major cause of ocular scarring and visual loss Simmons, Cutaneous infections HSV can infect virtually any part of the skin or mucosa.

Central nervous system infections Herpes simplex viruses cause a variety of peripheral and CNS illnesses of infectious and post-infectious nature Simmons, ; Schmutzhard, Infection in compromised hosts The likelihood of complicated HSV, with attendant substantial morbidity, parallels the degree of compromise of cellular immune function Rand et al. References Bader C. The natural history of recurrent facial—oral infection with herpes simplex virus. Baringer J. Recovery of herpes simplex virus from human trigeminal ganglions.

Bastian F. Herpesvirus hominis: Isolation from human trigeminal ganglion. Becker T. Grappling with herpes: herpes gladiatorum. Sports Med. Bernstein D. Comparison of Western Blot analysis to microneutralization for the protection of type-specific herpes simplex virus antibodies.

Belongia E. An outbreak of herpes gladiatorum at a high school wrestling camp. Boos J. Sporadic encephalitis I. Biopsy histopathology in herpes simplex encephalitis and in encephalitis of undefined etiology.

Yale J. Brown Z. Neonatal herpes simplex virus infection in relation to asymptomatic maternal infection at the time of labor. Buchman T. Restriction endonuclease fingerprinting of herpes simplex DNA: a novel epidemiological tool applied to a nosocomial outbreak. Carton C. Activation of latent herpes simplex by trigeminal sensory-root section. Cesario T. Chou J. The terminal sequence of the herpes simplex virus genome contains the promoter of a gene located in the repeat sequences of the L component.

Mapping of herpes simplex virus-1 neurovirulence to gamma 1 Corey L. Cellular immune response in genital herpes simplex virus infection. Genital herpes simplex virus infections: clinical manifestations, course and complications. Cushing H. Surgical aspects of major neuralgia of trigeminal nerve: report of 20 cases of operation upon the Gasserian ganglion with anatomic and physiologic notes on the consequences of its removal.

Eberle R. Cell-mediated immunity to herpes simplex virus: recognition of type-specific and type-common surface antigens by cytotoxic T cell populations. Feder H. Jr, Long S. Herpetic whitlow. Epidemiology, clinical characteristics, diagnosis, and treatment. Garcia J. Diagnosis of viral encephalitis by brain biopsy. Goodpasture E. Herpetic infections with special reference to involvement of the nervous system. Hesselgesser J. Chemokine and chemokine receptor expression in the central nervous system.

Hutto C. Intrauterine herpes simplex virus infections. Jenson H. Primary herpes simplex virus infection of a diaper rash. Kapur N. Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile.

Kimberlin D. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Kohl S. Neonatal antibody-dependent cellular cytoxic antibody levels are associated with the clinical presentation of neonatal herpes simplex virus infection.

Koskiniemi M. Cerebrospinal fluid alterations in herpes simplex virus encephalitis. Kuzushima K. Clinical manifestations of primary herpes simplex virus type 1 infection in a closed community.

Lakeman F. Roizman, Whitley, LopezLopez, C. Immunity to herpesvirus infections in humans. In The Human Herpesviruses , ed. New York: Raven Press, — Lowhagen G. Self-reported herpes labialis in a Swedish population. McMill S. Herpes simplex virus infection in a pediatric burn patient: case report and review. McMillan J. Pharyngitis associated with herpes simplex virus in college students. Martin S. Herpes simplex virus type 1 specific cytotoxic T lymphocytes recognize virus structure proteins.

Mertz G. Risk factors for the sexual transmission of genital herpes. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy, and prophylaxis.

This article is aimed at all health-care providers managing patients with herpes genitalis and attempts to improve the often suboptimal counseling, targeted use of laboratory diagnostics, treatment, and preventive measures provided to patients.

While HSV-1 often affects the perioral region and can be known to cause genital lesions, HSV-2 is more commonly the consideration when patients present with genital lesions.