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Chapter 135: Herpes Simplex

E.J. Mayeaux, Jr.

PATIENT STORY

A 32-year-old man presents with complaints of a 1-week history of multiple painful vesicles on the shaft of his penis associated with tender groin adenopathy (Figure 135-1). The vesicles broke 2 days ago and the pain has increased. He had similar lesions 1 year ago but never went for a healthcare examination at that time. He has had 3 different female sexual partners in the past 2 years but has no knowledge of them having any sores or diseases. He was given the presumptive diagnosis of genital herpes and a course of acyclovir. His herpes polymerase chain reaction (PCR) came back positive, and his rapid plasma reagin (RPR) and HIV tests were negative.

FIGURE 135-1

Recurrent genital herpes simplex virus on the penis showing grouped ulcers (deroofed vesicles). (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows ulcerous lesions in the penis. Lesions are clustered and appear as pale pink depressions with red spots, exposing the skin within.
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INTRODUCTION

Herpes simplex virus (HSV) infection can involve the skin, mucosa, eyes, and central nervous system. HSV establishes a latent state followed by viral reactivation and recurrent local disease. Perinatal transmission of HSV can lead to significant fetal morbidity and mortality.

EPIDEMIOLOGY

HSV affects more than one-third of the world's population, with the 2 most common cutaneous manifestations being genital (Figures 135-1, 135-2, 135-3, 135-4) and orolabial herpes (Figures 135-5, 135-6, 135-7).1

FIGURE 135-2

Herpes simplex on the penis with intact vesicles and visible crusts. (Reproduced with permission from Eric Kraus, MD.)

A photo shows vesicular lesions in the penis. These appear as reddish blisters with crusts on the surface.
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FIGURE 135-3

Vulvar primary herpes simplex virus at the introitus showing vesicles, pustules, and ulcers in this pregnant woman. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows lesions in the vulva, appearing as pale yellow vesicles and ulcers.
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FIGURE 135-4

Recurrent herpes simplex virus on the buttocks of a woman with clusters of vesicles. Women are prone to getting buttocks involvement owing to sleeping with partners who have genital involvement. (Reproduced with permission from Flowers H, Brodell RT. Recurrent vesicular rash over the sacrum. J Fam Pract. 2015 Sep;64(9):577-579.)

A photo shows reddish patches in the buttocks. Each patch contains numerous pale pink blisters.
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FIGURE 135-5

Primary herpes gingivostomatitis presenting with multiple ulcers on the tongue and lower lip. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows dark red, round ulcerous lesions on the lips and tip of tongue.
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FIGURE 135-6

Close-up of recurrent herpes simplex virus-1 showing vesicles at the vermilion border. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows vesicles filled with clear fluid, clustered around the corner of mouth.
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FIGURE 135-7

Orolabial herpes simplex virus in an adult woman showing deroofed blisters (ulcer). (Reproduced with permission from ...

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