Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

702 Herpes Labialis Herpes Simplex

complications and prognosis

■chronic recurrences

■avoid irritating associated factors

■contagious from viral shedding first 3 to 5 days

Herpes Simplex......................................

JEFFREY P. CALLEN, MD

history & physical

History

■Primary disease is often clinically unapparent and asymptomatic.

■Recurrent disease is frequently preceded by symptoms of itching or

burning.

■Herpes simplex virus has two distinct variants – HSV 1 and HSV 2.

■Although either variant can affect any surface on the body, HSV 1

is more common on the lips and HSV 2 is more common on the

genitalia or buttocks.

■Recurrences are often triggered by trauma, fever, sunburn or stress.

■Primary disease on the fingers and subsequent recurrences are more

frequent in dentists, dental assistants, and respiratory therapists and

are termed herpetic whitlow (this is less common with the use of

universal precautions and gloves).

■Atypical clinical appearances are more frequent in patients who are

immunosuppressed either due to disease (cancer, HIV, etc.) or to

immunosuppressive medications.

Signs & Symptoms

■Classic presentation includes grouped vesicles on the affected site.

■Often patients present with crusting that follows the resolution of

the vesicular lesions.

■Chronic scalloped ulceration is possible in patients who are immu-

nosuppressed.

tests

■Tzanck smears are frequently positive.

■Culture for the virus from a fresh lesion

■Biopsy may reveal characteristic viral changes, but is usually not

necessary.