Which physical findings are characteristic of herpes simplex virus (HSV) infection?

Updated: Mar 17, 2020
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Clinical herpes simplex virus (HSV) infections appear as clustered vesicles on an erythematous base. They often progress to pustular or ulcerated lesions with a scalloped border, and they eventually form a crust. HSV lesions tend to recur at or near the same location within the distribution of a sensory nerve. Systemic symptoms, such as fever, malaise, and acute toxicity, may accompany the lesions, especially in primary infections. Each condition has associated symptoms and clinical findings (see History).

Although HSV infections may occur anywhere on the body, 70-90% of HSV-1 infections occur above the waist. In contrast, 70-90% of HSV-2 infections occur below the waist.

Physical manifestations of HSV infections in patients who are immunocompromised are usually similar to those in healthy patients. However, larger lesions or necrotizing ulcers may occur, and widespread areas may be involved. Additionally, immunocompromised patients or those with HIV infection may present with vegetative tumorlike nodules. [41] HSV-2 is detected in 86% of mucocutaneous tumoral HSV and 97% of cases occur in the setting of immunosuppression. [42] The majority of these tumorlike HSV nodules occur in the anogenital region (76%) and they occur more frequently in men. [42]

Neonatal HSV may be difficult to diagnose because, often, no mucocutaneous lesions are present on physical examination. Respiratory distress, jaundice, and seizures may occur.

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