Herpes Simplex Virus Infection Đánh giá ban đầu

Clinical Presentation

Orolabial Herpes Simplex Virus Disease  

Orolabial herpes simplex virus disease may be asymptomatic but may present with the following:

• Painful vesicles and ulcerative lesions on the tongue, palate, gingiva, buccal mucosa, or lips
• Three to five lesions typically appear at the vermillion border of the lips (cold sores)
• Lesions become more pustular, ulcerative and crusted within 72-96 hours; pain resolves soon after that
• Edema of the oropharynx causes difficulty in swallowing (sore throat)
• Halitosis
• Drooling which may bring about lesions in the chin and neck
• Cervical lymphadenopathy
• Systemic symptoms: Fever myalgia, malaise, flu-like symptoms

Disease duration of orolabial herpes simplex virus disease is around 2-3 weeks. Recurrent HSV-1 infection usually affects the lips and perioral area and is rarely associated with systemic symptoms.

Herpes Simplex Virus Infection_Initial Assesment 1

• Atypical presentations include small erosions or fissures and urethritis or dysuria without lesions
• Local symptoms: Pain, itching, dysuria, vaginal and urethral discharge, tender inguinal lymphadenopathy
• Systemic symptoms: Fever, headache, myalgia, abdominal pain
• Lesions in varying stages (eg vesicles, pustules or ulcers)

Infection in men may present with lesions usually occurring on the prepuce, glans penis, penile shaft; usually with 6 to 10 vesicles. Perianal infection and proctitis may be common in homosexual men. Systemic complications rarely occur in men, though aseptic meningitis has been reported. Extragenital areas (eg buttocks, perineum, or thighs) may also be affected.  

Genital herpes simplex virus disease tends to cause more severe infections and a higher rate of complications in women. Lesions may occur on the vulva, cervix, vagina, clitoris, urethral or perianal skin, as well as extragenital areas. These painful lesions contain a large amount of infectious viral particles which are excreted over 3 weeks. Systemic complications can include urinary retention syndrome, aseptic meningitis, transverse myelitis, sacral radiculopathy, extragenital lesions, disseminated infections, and superinfection with bacteria or fungi.  

Primary genital herpes simplex virus infection is different from recurrent infection in that it is often more painful, extensive, and prolonged, more likely to be bilateral, and presents with lymphadenopathy and systemic symptoms. While recurrent infections are characterized by fewer lesions, complaints of paresthesia 1 to 2 days before eruption of lesions, unilateral lesions which are generally in the same area, and history of recurrences. Recurrent infection can be triggered by physical or psychological stress, excessive intercourse, alcohol consumption, and menstruation. The duration of the disease ranges from 2 to 4 weeks.

Herpes Simplex Virus Infection_Initial Assesment 2

Diagnosis or Diagnostic Criteria

Diagnosis of herpes simplex virus is usually based on distinctive lesions. Lab tests may be done to confirm diagnosis and in cases wherein lesions are atypical, patients have a central nervous system (CNS) disease or severe infection, or are pregnant, immunocompromised, or a neonate.