Continuing medical educationHuman herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management
Introduction
More than 80 herpesviruses have been identified, 8 of which are known human pathogens.1, 2, 3 Herpes simplex viruses belong to the ubiquitous Herpesviridae family of viruses, which comprises herpes simplex virus-1 (HSV-1), herpes simplex virus-2 (HSV-2), varicella zoster virus, cytomegalovirus, Epstein-Barr virus as well as human herpesviruses 6 and 7 and Kaposi's sarcoma–associated herpesvirus (type 8).4, 5, 6 HSV-associated diseases are among the most widespread infections, affecting nearly 60% to 95% of human adults.7, 8 They are incurable and persist during the lifetime of the host, often in latent form. Their clinical manifestations are variable and influenced by the portal of viral entry, degree of host immune competence as well as primary or secondary nature of the disease.8 Clinical presentations of HSV infection range from asymptomatic infection to mucocutaneous conditions such as orolabial, ocular, and genital herpes, herpetic whitlow, herpes gladiatorum, and eczema herpeticum as well as central nervous complications such as neonatal herpes and herpetic encephalitis and fatal dissemination, a particular threat in the immunosuppressed host.8, 9, 10
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Structure and biological properties
All human herpesviruses measure approximately 200 nm in diameter and contain a linear, double-stranded DNA core of approximately 150 kilo base pair (Kbp) enclosed within a protein capsid, covered by a tegument and a glycoprotein-containing envelope.4, 5, 9, 11, 12, 13 The expressed pattern of alpha, beta, and gamma genes respectively control translation of viral genome, transcription of proteins essential for viral DNA synthesis, and collection/exit of viral particles from the infected cell.4
Primary herpetic gingivostomatitis
Irrespective of the viral type, HSV primarily affects skin and mucous membranes.11 Primary herpetic gingivostomatitis (PHGS) is the most common orofacial manifestation of HSV1 infection and is characterized by oral and/or perioral vesiculoulcerative lesions.8, 73 PHGS typically develops after first-time exposure of seronegative individuals or those who have not produced adequate antibody response during a previous infection with either of the two HSVs.10, 11, 13 A majority of infections are
Diagnosis
The mode of onset, classic constitutional symptoms, appearance and distribution of lesions, absence of prior herpetic episodes on history, and reported exposure to HSV1 often establish the diagnosis of primary herpetic gingivostomatitis.9, 12, 25, 72, 73 The presence of multiple, round, superficial oral ulcerations as well as acute, generalized marginal gingivitis on clinical examination are especially helpful in diagnosis.72 Occasionally, diagnosis of primary HSV infections poses a challenge,
Management
In general, management of HSV infections starts with prevention. Examples of appropriate preventive strategies include education of the public regarding the contagious nature of the disease, its potential for autoinoculation, efficacy of barrier techniques such as condoms in preventing viral transmission, asymptomatic viral shedding, triggers, and prophylactic antiviral therapy.2, 9, 12, 36, 69, 72, 73, 90, 228
An overall evaluation of the clinical signs, symptoms, and general health of the
Conclusion
Mucocutaneous infections caused by HSVs are common in the general population. Although not a major concern in most healthy individuals, frequent outbreaks are often associated with inconvenience, cosmetic concerns, and psychological distress. Such infections may also lead to significant morbidity or mortality in those unable to mount sufficient immune response. Although recent scientific advances have dramatically improved our understanding of the HSV pathogenesis, diagnosis, and treatment, a
References (297)
- et al.
Reactivation of herpes simplex virus
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1997) - et al.
Treatment of herpes simplex infections
Antiviral Res
(2004) - et al.
Herpes simplex virus infections
Lancet
(2001) - et al.
Management of acyclovir-resistant herpes simplex virus
Dermatol Clin
(2003) Oral viral infections
Clin Dermatol
(2000)- et al.
A retrospective study of the prevalence and incidence of recurrent aphthous ulcers in a professional population, 1958-1971
Oral Surg Oral Med Oral Pathol
(1977) The herpes simplex problem
J Am Acad Dermatol
(1988)Herpesvirus infections
Dent Clin North Am
(1996)- et al.
Systemic dermatologic therapy: antiviral agents
Dermatol Clin
(2001) First-episode, recurrent, and asymptomatic herpes simplex infections
J Am Acad Dermatol
(1988)
HSV shedding
Antiviral Res
A clinical study for the control of facial mucocutaneous herpes virus infections. I. Characterization of natural history in a professional school population
Oral Surg Oral Med Oral Pathol
Prevention of ultraviolet light induced herpes labialis by sunscreen
Lancet
The histopathologic evolution of recurrent herpes simplex labialis
J Am Acad Dermatol
Diagnosis and management of recurrent herpes simplex infections
J Am Dent Assoc
The clinical characteristics of intraoral herpes simplex virus infection in 52 immunocompetent patients
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Genital herpes simplex virus infections
Med Clin North Am
Prophylaxis of herpesvirus infections in immunocompetent and immunocompromised older patients
Drugs Aging
Genital herpes: a review
Am Fam Physician
Current and potential therapies for the treatment of herpes simplex infections
Prog Drug Res
Novel agents and strategies to treat herpes simplex virus infections
Expert Opinion
Kaposi's sarcoma: an update
J Surg Oncol
Novel approach for specific detection of herpes simplex virus type 1 and 2 antibodies and immunoglobulin G and M antibodies
Clin Diagn Lab Immunol
Herpes simplex virus infections
Postgrad Med
A risk-benefit evaluation of acyclovir for the treatment and prophylaxis of herpes simplex virus infections
Drug Saf
Herpes simplex and aphthous ulcerations: presentation, diagnosis and management—an update
Gen Dent
Herpes simplex and varicella-zoster infections: clinical and laboratory diagnosis
Gen Dent
Virological aspects on herpesvirus infections
Scand J Infect Dis
Herpes simplex virus infection: what to look for? What to do!
J Can Dent Assoc
Clinical manifestations and treatment considerations of herpes simplex virus infection
J Infect Dis
Human herpesviruses: a consideration of the latent state
Microbiol Rev
Latent herpes simplex virus in spinal ganglia of mice
Science
Molecular aspects of herpes simplex virus latency, reactivation and recurrence
Crit Rev Oral Biol Med
Detection of herpes simplex virus type 1 shedding in the oral cavity by polymerase chain reaction and enzyme-linked immunosorbent assay at the prodromal stage of recrudescent herpes labialis
J Oral Pathol Med
Genital herpes
Recurrence rates in genital herpes after symptomatic first-episode infection
Ann Intern Med
Genital herpes: review of the epidemic and potential use of type-specific serology
Clin Microbiol Rev
Herpes simplex viruses
Clin Infect Dis
Establishment, maintenance and control of herpes simplex virus (HSV-1) latency
An inquiry into the mechanism of herpes simplex virus latency
Annu Rev Microbiol
Shedding and survival of herpes simplex virus from “fever blisters”
Pediatrics
Transmission of genital herpes in couples with one symptomatic and one asymptomatic partner: a prospective study
J Infect Dis
Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons
N Engl J Med
Infections with herpes simplex viruses (1)
N Engl J Med
Pathogenesis of herpes simplex labialis; excretion of virus in the oral cavity
J Clin Microbiol
Herpes simplex virus, sunlight and immunosuppression
Rev Med Microbiol
Mechanisms of herpes simplex virus type 1 reactivation
J Virol
The many challenges of facial herpes simplex virus infection
J Antimicrobiol Chem
The heterogenous clinical spectrum of genital herpes
Dermatology
Reactivation of herpes simplex virus after decompression of the trigeminal nerve root
J Infect Dis
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Conflicts of interest: None declared.