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- Daniel Ruderfer, MD*
- Leonard R. Krilov, MD*,†
- *Department of Pediatrics, Children’s Medical Center, Winthrop University Hospital, Mineola, NY
- †Department of Pediatrics, State University of New York at Stony Brook School of Medicine, Stony Brook, NY
AUTHOR DISCLOSURE
Drs Ruderfer disclosed no financial relationships relevant to this article. Dr Krilov dislcosed that he has research grants from Pfizer Inc and AstraZeneca plc (Medimmune LLC). This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Two ubiquitous members of the 9-member human herpesvirus (HHV) family are herpes simplex virus (HSV) 1 and 2, which belong to the α-herpesvirus subfamily. The common sites of their clinical presentation are the oral and genital mucocutaneous areas, and both viruses can infect nerve cells and remain dormant for the long term in the sensory ganglia. Classic lesions initially appear as fluid-filled vesicles, which later become pustular and ultimately dry out and crust over. However, most infected individuals do not have any clinical manifestation either at the time of initial acquisition or during episodes of reactivation. The host's immune status has a strong influence on disease severity, as does whether infection is primary or recurrent. Recognizing the wide variety of clinical presentations, as well as knowledge of course progression, is invaluable for patient management and family counseling.
Both forms of HSV can infect either oral or genital mucocutaneous sites, with HSV-1 predominately infecting oral sites and HSV-2 mainly infecting genital sites. Even in persons initially infected at both oral and genital sites with HSV-1 or HSV-2, HSV-1 is more likely to recur at oral sites, and HSV-2 reactivates more frequently in the genital areas. HSV infection can become invasive, causing severe disease, but this is uncommon and may represent a state of immunodeficiency. Polymerase chain reaction (PCR) is considerably more sensitive than is culture of vesicular fluid for detection of HSV on mucosal surfaces. The sensitivity of viral culture decreases as lesions heal. For patients who have no active lesions but a history of genital ulcers, diagnosis …
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