HSV-1 & -2 Complications and Neonatal Herpes

Herpes Simplex Virus (HSV-1 & -2)

• Exposure to UV and sunlight, menstruation, and emotional stress can trigger HSV reactivation
• HSV-1 is more common than HSV-2, with over 60% of adults infected with HSV-1 and 11-30% with HSV-2

Complications

• Dendritic ulcers: refer to an ophthalmologist
• Encephalitis: infection of the brain parenchyma, high morbidity and mortality
• Neonatal herpes: high morbidity and mortality, symptoms include skin, eyes, and mouth lesions, CNS disease, and disseminated disease

Diagnosis

• Molecular testing: Cerebrospinal fluid (CSF)
• Serology: serum, check for a four-fold rise in IgG, confirm previous exposure

Treatment and Prophylaxis

• Treatment within 48 hours after onset of symptoms: decrease severity and shorten course of disease
• Antiviral medications: acyclovir, valacyclovir, famcyclovir
• No vaccine available
• Infection control: perform caesarean section if possible, dentist with herpetic whitlow should only continue working after complete healing, patients should inform dentist if they have an active herpes labialis infection

Herpesvirus Summary

• HHV-1: Herpes simplex virus 1, causes herpes labialis, gingivostomatitis, pharyngitis, encephalitis, conjunctivitis, and herpetic whitlow
• HHV-2: Herpes simplex virus 2, causes genital herpes, neonatal herpes, encephalitis, and meningo-encephalitis
• HHV-3: Varicella-zoster virus, causes chickenpox and shingles
• HHV-4: Epstein-Barr virus, causes infective mononucleosis, oral hairy leukoplakia, and lymphoproliferative disorders and cancers
• HHV-5: Cytomegalovirus, causes mononucleosis-like syndrome, and is associated with certain cancers
• HHV-6 and HHV-7: cause Roseola infantum and exanthem subitum, respectively
• HHV-8: causes Kaposi's sarcoma and primary effusion lymphoma

Primary Infection, Latency, and Reactivation

• Primary infection: occurs when the virus first enters the body
• Latency: the virus remains dormant in the sensory neuron in the dorsal root ganglion
• Reactivation: the virus reactivates and travels down the peripheral nerve to cause symptoms, often triggered by stress

HSV-1 & -2

• Background: HSV-1 is more common than HSV-2, with over 60% of adults infected with HSV-1 and 11-30% with HSV-2
• Transmission: direct skin contact, vertical transmission, contact with mucosal secretions, and contact through surfaces (rare)
• Primary infection: gingivostomatitis, pharyngitis, herpetic whitlow, gladiatorum, and genital lesions
• Reactivation: herpes labialis, recurring genital lesions