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Herpes simplex virus (HSV) infections are ubiquitous and have a wide range of clinical manifestations (see the images below). These drugs may stop viral replication in the skin but do not eliminate HSV from the body or prevent later outbreaks (HSV reactivation).
Herpes gladiatorum (mat herpes) is a skin infection caused by herpes simplex virus type 1 (HSV-1) , the same virus that causes cold sores on the lips. A nucleic acid amplification test (NAAT) of vesicle fluid, genital or mouth swabs is the standard diagnostic method, although the virus grows readily and can be visualized by electron microscopy (EM).
Topical, oral and intravenous preparations of aciclovir and other agents with better oral absorption, including valaciclovir and famci-clovir, are available.
Varicella zoster virus (VZV), which has only one serological type, causes the acute primary infection known as chickenpox and its recurrence, which is called shingles. Herpes infections are caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
The ratio between serum and CSF antibody may indicate local production and can help in the diagnosis of HSV encephalitis. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes.


This image displays grouped blisters within an inflamed area of skin typical of herpes simplex. MRI or CT scans of the brain may detect temporal lobe lesions that are typical of herpes encephalitis.
The most common clinical presentation of first-episode, primary herpes simplex virus infection in children (usually aged 6 mo to 5 y) is acute herpetic gingivostomatitis, as is shown in the image below. The transmission of herpes simplex virus (HSV) infection is dependent upon intimate, personal contact of a susceptible seronegative individual with someone excreting HSV. It results in painful herpes simplex virus lesions, frequently with numerous cutaneous vesicles. Virus must come in contact with mucosal surfaces or abraded skin for infection to be initiated. Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides. Herpes labialis infection occurs when the herpes simplex virus comes into contact with oral mucosal tissue or abraded skin of the mouth. Painful diseases caused by herpes simplex virus (HSV) or varicella zoster virus (VZV, also causes chickenpox).


Infection by the type 1 strain of herpes simplex virus (HSV-1) is most common; however, cases of oral infection by the type 2 strain are increasing. All that body bashing and face-to-face smearing in contact sports does wonders for spreading skin or cutaneous infections.
Two types are distinguished: type 1 (HSV-1) is generally associated with most oral (cold sores) and central nervous system infections, and type 2 (HSV-2) with genital herpes. Zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons.
Shortly thereafter, this workgroup reformed as the ACIP shingles workgroup and, during subsequent months, held 19 conference calls to review and discuss scientific evidence related to herpes zoster and zoster vaccine, including the epidemiology and natural history of zoster and its sequelae, and the safety, immunogenicity, efficacy, financing, storage, and handling of the zoster vaccine.



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