Internal Medicine

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

704 Herpes Type 1/Type 2

■Transmission via close contact or sexual activity, subclinical shed-

ding HSV occurs frequently

■Primary mechanism of transmission HSV-1 in saliva, HSV-2 is usually

by sexual contact

■Both HSV-1 and HSV-2 can be transmitted to sites via oral-genital,

oral-anal or anal-genital contact.

■Transmission to neonate usually via birth canal

■Health care personnel can acquire infection from patients.

■Incubation period (non-neonatal): 2 days-2 weeks

■HSV-1 is extremely common infection, often acquired in childhood

■HSV-1 seroprevalence in US∼70% adult population

■HSV-1 accounts for most of oral herpes, sometimes due to HSV-2

■HSV-1 as cause of genital herpes likely increasing (20–24% cases),

while remainder HSV2

■HSV-2 infection rarely occurs before onset of sexual activity.

■∼20% of adults infected with HSV-2

■Herpes encephalitis usually due to HSV-1

Signs & Symptoms

Oral Herpes

■Primary infection:

➣Approximately one-third of cases develop gingivostomatitis/

pharyngitis.

➣Lesions on hard and soft palate, gingival surfaces, tongue and lip

➣May also have fever, difficulty swallowing and painful cervical

lymphadenopathy

➣Occasional features (esp in pediatrics):

malaise

irritability

earache/otitis media (serous effusion)

coryza

■Reactivation:

➣often prodrome of tingling, pain and/or itching

➣small cluster of vesicles usually on lips (not as extensive as pri-

mary

Genital

■First episode, broad spectrum of disease:

➣bilateral vesiculopustular lesions

➣tender inguinal adenopathy

➣fever

➣headache