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Updated: Jul 25 2020

HSV Type 2

  • Snapshot
    • A 22-year-old man presents to an urgent care clinic for a severe painful genital ulcer. His symptoms are associated with fever, headache, myalgias, and dysuria. He has a medical history of asthma. Social history is significant for having multiple recent sexual partners while not using condoms. Physical examination is significant for a genital ulcer with associated tender inguinal lymphadenopathy. A polymerase chain reaction returns positive for HSV2 infection.
  • Introduction
    • Classification
      • an enveloped, linear, double-stranded DNA virus from the Herpesviridae family
    • Epidemiology
      • incidence
        • most cases of recurrent genital herpes are caused by HSV2
    • Transmission
      • sexual contact
      • perinatal
    • Pathogenesis
      • HSV2 inoculates in the mucous membrane or skin after close contact with the skin or genital secretions of a patient with viral shedding
        • cytolytic replication occurs in the epithelial cells where the virus enters, which then travels to the sensory dorsal root ganglia, where it lies dormant
    • Prognosis
      • immunocompromised patients have more severe herpetic episodes with frequent viral reactivation
  • Presentation
    • Symptoms/physical exam
      • painful genital ulcers
      • dysuria
      • fever
      • inguinal lymphadenopathy
  • Studies
    • Making the diagnosis
      • based on the patient's history and physical exam, which is confirmed by laboratory testing
    • Confirmatory testing includes
      • viral culture
      • polymerase chain reaction (PCR)
      • direct fluorescence antibody
      • serological testing
    • Tzank smear
      • demonstrates multinucleated giant cells (intranuclear eosinophilic Cowdry A inclusions)
        • seen in HSV1, HSV2, and VZV infections
  • Differential
    • Chancre
      • differentiating factor
        • abnormal VDRL and RPR testing
  • Treatment
    • Medical
      • acyclovir, famciclovir, or valacyclovir
        • indications
          • immunocompromised patients
          • patients with frequent outbreaks
  • Complications
    • Neonatal herpes
    • Disseminated vesicular rash
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