Herpes Simplex Virus
Our understanding of human herpes simplex virus (HSV) has increased tremendously since the early descriptions of disease provided by Hippocrates [1, 2]. Notable advances include the correlation of herpetic lesions with genital infections in the eighteenth
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Herpes Simplex Virus Rachel Gordon and Stephen Tyring
13.1
Introduction
Our understanding of human herpes simplex virus (HSV) has increased tremendously since the early descriptions of disease provided by Hippocrates [1, 2]. Notable advances include the correlation of herpetic lesions with genital infections in the eighteenth century [3] and Vidal’s recognition of human-to-human transmission in 1893 [2]. Antigenic differences between HSV subtypes, suspected on clinical observations by Lipschitz [4], were confirmed in 1968 [5]. In modern day, there is successful antiviral treatment available for most HSV infections [6]. Insight into the viral life cycle and gene expression has been a driving force behind the development of antiviral treatment, including new vaccines and gene therapy [4].
13.2
Background
Transmission of HSV occurs when a mucosal surface or abraded skin in a seronegative individual comes into contact with virus. Viral replication at the site of primary infection is followed by retrograde axonal transportation of a virion to the dorsal ganglion cells where latency is established by another episode of viral replication [12]. Recurrent infections occur randomly, but there is a positive correlation with
R. Gordon, M.D. (*) Department of Dermatology, The University of Texas Medical School at Houston, 6655 Travis Street, Suite 600, Houston, TX 77030, USA e-mail: [email protected] S. Tyring, M.D., Ph.D., M.B.A. Department of Dermatology, The University of Texas at Houston, Houston, TX, USA e-mail: [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_13, © Springer Science+Business Media New York 2014
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stress, immunosuppression, UV light, fever, and tissue damage [4, 7]. The severity of the initial infection correlates with the chance of recurrence. Rarely, lifethreatening infections occur in cases of severe immune compromise, pregnancy, and neonatal disseminated HSV. “Primary infections” are considered first-time events, but their occurrence in seropositive individuals indicates that latent infection can be established without prior symptoms [6]. HSV infections are ubiquitous, even in remote areas [8]. More than 57 % of the US population between the ages of 14 and 49 are seropositive for HSV1 [9]. Incidence correlates with age in a linear fashion, globally reaching 60–90 % in older adults [10]. HSV1 is most commonly transmitted in childhood and adolescence. The overall incidence of HSV1 is significantly higher than that of HSV2 [10], which occurs more commonly in women and in subpopulations with high-risk sexual behavior [4, 10]. Humans are the only reservoir for HSV infection, and there have been no reported animal vectors [4].
13.3 13.3.1
Clinical Presentation Oropharyngeal and Orolabial HSV
Infections around the mouth are the most common sites and reservoirs of HSV. Primary infection is usually asymptomatic [11]. Symptomatic cases may include extensive orolabial vesiculo-ulce
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