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Genital HSV is the most common sexually transmitted infection (STI) in both men and women, but as many as 90% don’t know they are infected because their symptoms are too mild to notice or mistaken for another condition. Symptomatic genital herpes is characterized by a burning and itching sensation in the genitals, followed by blistering. HSV skin lesions usually appears as small blisters or sores around the mouth, nose, genitals, buttocks, and lower back, though infections can develop almost anywhere on the skin.
This photo shows HSV-1 lesions on the buttock of a five-year-old girl — also called sacral herpes simplex. Herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx.
Serologic testing for HSV has limited value in acute clinical diagnosis because of the time delay for seroconversion following initial infection. Acyclovir, valacyclovir and famciclovir are the most commonly used agents for treating HSV infections.
A wide disparity exists between the public and medical community regarding the significance of herpes infections.
The majority of recurrent oral herpes cases are caused by herpes simplex virus type 1 (HSV-1) and the majority of genital herpes cases are caused by HSV-2. Differentiating between the two types of infection using either type specific swab testing, preferably PCR, or type specific IgG antibody testing, is very important because HSV-1 genitally recurs less, is shed less, and presents far less risk of transmission to others than HSV-2.
Fifty seven percent of Americans between 14 and 49 have HSV-1, and 16% of the same group has HSV-2 infection.
In women who contract the disease, the cervix is infected 80% to 90% of the time during primary infection. This photo shows a close-up of lesions on the upper eyelid in a 20-year-old male patient due to HSV-1.


Of patients who develop seropositivity, 65% do so within six weeks, while approximately 20% do not make antibodies for six months.
While all three drugs decrease the duration and severity of illness and viral shedding, they have no effect on nonreplicating viruses, nor do they eliminate the virus from the ganglia. Although treatment options exist, respondents in one survey considered contracting herpes as worse than breaking up with a significant other, getting fired from a job, or failing a course in school.
HSV infection is a persistent and chronic infection of the sensory ganglia with a varying, unpredictable degree of skin expression. Acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage associated with herpes simplex virus type I.
Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis: Case report and review of the literature.
An unusual late complication of intracerebral haematoma in herpes encephalitis after successful acyclovir treatment. A case of herpetic meningoencephalitis associated with massive intracerebral hemorrhage during acyclovir treatment: A rare complication. Primary infections can range from subclinical to severe, with fever, headache, malaise, anorexia, pain, lymphadenopathy and edema. Clinical recurrence occurs on average 3 to 4 times a year, but some patients experience monthly outbreaks. Cervical infection alone is rarely symptomatic, but because the cervix is not sensitive to pain, infection may pass unnoticed.
Be sure to provide adequate counseling to help patients put their diagnosis in perspective.
This slideshow will highlight variations in presentation and provide more information about diagnosis and treatment.


Petechial cortical hemorrhages are common in HSV encephalitis, whereas frank hematoma is extremely rare; only 10 cases have been reported in the literature. Albanese Journal of Neurology, Neurosurgery & Psychiatry.
Brain computed tomography (CT) on day 2 showed a slightly low-density area in the medial side of the right temporal lobe, with an obscured sulcus [Figure 1]a.
Brain fluid-attenuated inversion recovery magnetic resonance imaging (MRI) on day 7 showed a focal area of increased signal in the right temporal lobe [Figure 1]b. However, brain CT scan on day 10 showed a hematoma in the right medial temporal lobe, without mass effect [Figure 1]c.
The hematoma location was in the medial temporal lobe in six patients and exhibited a gyral pattern, which differed from spontaneous intracerebral hematoma. Hemorrhagic complication occurred during acyclovir treatment (5-15 days) in six patients, suggesting that initiation of treatment may not affect this complication.
Gyral pattern of the hemorrhage may suggest that the hemorrhagic complication in HSV encephalitis may be due to associated vasculitis. Hematoma formation in the cases described here tended to occur at a relatively late stage (mean interval from onset to hematoma formation, approximately 12 days), which supports this hypothesis.



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