Herpes simplex

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The Herpes simplex virus (HSV) is the cause of cold sores, sexually transmitted disease (genital herpes) and ulcers. Accordingly a very successful virus as it infects over 60% of those under 50 worldwide although incidence is slightly lower in the Americas[1][2]. Neonatal herpes simplex can be a serious disease for the unborn child. Herpes simplex encephalitis is also serious, as is infection in the immunocompromised (including pregnancy), which can result in fulminant hepatic failure and myocarditis. Herpes simplex virus is a likely cause of Bell's palsy.


Herpes simplex virus (HSV). Large, complex, DNA. There are two types of HSV, HSV 1 and HSV 2. Like other members of the family Herpesviridae, HSV establishes lifelong latency. HSV can reactivate when the host is immunocompromised, although the exact trigger is often not identified.



HSV 1 is usually associated with oral HSV infections. HSV 2 is usually associated with genital herpes infections. However either HSV type can be found at either site, with sexual activity distinctly contributing to exposure to both types. Recent changes in HSV epidemiology have showed an increase in genital and neonatal herpes particularly caused by HSV-1.[3]

  • Cold sores
  • Genital herpes
  • HSV encephalitis
  • Characteristic rash
  • Association rash and systemic or CNS disease
  • Systemic herpes simplex in the immunosuppressed or pregnant
    • This can be a life threatening disease with hepatitis and wide other organ involvement


Laboratory Tests

  • Direct fluorescent antibodies
  • Tzanck preparation
  • Immunofluorescence using HSV specific monoclonal antibodies
  • Cell culture
  • HSV serology by ELISA. Both type-specific and non type-specific HSV serology are available.
  • Lumbar puncture in suspected viral encephalitis


  • MRI and CT in suspected encephalitis




  • Treat cold sores. Not assume benign in pregnancy or the immunocompromised.
  • Avoid unprotected sexual or oro-genital intercourse with multiple partners.


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