Dermatologic Manifestations of Herpes Simplex Workup
- Author: Joseph S Eastern, MD; Chief Editor: William D James, MD more...
Detection and typing of herpes simplex virus (HSV) can be completed by obtaining a viral culture from skin vesicles. Early in the course of recurrent infection, 80-90% of viral cultures of untreated lesions are positive, but the false-negative rate increases after 48 hours of lesion onset.
HSV DNA detection is performed in specific instances by polymerase chain reaction (PCR).
The virus may be isolated from cerebrospinal fluid (CSF) (in newborns), stool, urine, throat, anogenital mucosa, nasopharynx, and conjunctivae. HSV-1 DNA has also been detected in tears and saliva.
In the office, a Tzanck smear can be performed as a rapid test for the presence of multinucleated giant cells, though the findings are not specific for the type of herpes virus. A Tzanck smear is prepared by scraping the floor of the herpetic vesicle; samples may be stained with either a Wright stain or a Papanicolaou stain. Approximately 50% of the results are positive.
Direct fluorescent antibody testing may be used on air-dried smears, and approximately 75% of the results are positive.
Serologic assays to detect antibodies against HSV-1 and HSV-2 may be useful in identifying organ transplant recipients or pregnant women who may be at risk for HSV reactivation. Their use is also becoming more common for confirming infection and for testing of partners or those with asymptomatic infection. Enzyme-linked immunosorbent assays (ELISAs) and several other HSV-1 and HSV-2 serologic assays that can detect antibodies against these viruses are available. A rapid HSV-2 POCKit test is now commercially available and has a high sensitivity. Western blot assays are highly sensitive and specific, but they are only available for research purposes.
Immunoperoxidase techniques may be used to distinguish HSV-1 and HSV-2 antigens in formalin-fixed tissue samples.
Cells infected with HSV demonstrate ballooning and reticular epidermal degeneration; epidermal acantholysis and intraepidermal vesicles are common. Intranuclear inclusion bodies, steel-grey nuclei, multinucleate giant keratinocytes, and multilocular vesicles may also be present.
Margolis TP, Imai Y, Yang L, Vallas V, Krause PR. Herpes simplex virus type 2 (HSV-2) establishes latent infection in a different population of ganglionic neurons than HSV-1: role of latency-associated transcripts. J Virol. 2007 Feb. 81(4):1872-8. [Medline].
Hellenbrand W, Thierfelder W, Müller-Pebody B, Hamouda O, Breuer T. Seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in former East and West Germany, 1997-1998. Eur J Clin Microbiol Infect Dis. 2005 Feb. 24(2):131-5. [Medline].
Singh AE, Romanowski B, Wong T, Gourishankar S, Myziuk L, Fenton J, et al. Herpes simplex virus seroprevalence and risk factors in 2 Canadian sexually transmitted disease clinics. Sex Transm Dis. 2005 Feb. 32(2):95-100. [Medline].
Levett PN. Seroprevalence of HSV-1 and HSV-2 in Barbados. Med Microbiol Immunol. 2005 Jan. 194(1-2):105-7. [Medline].
Xu F, Markowitz LE, Gottlieb SL, Berman SM. Seroprevalence of herpes simplex virus types 1 and 2 in pregnant women in the United States. Am J Obstet Gynecol. 2007 Jan. 196(1):43.e1-6. [Medline].
Boivin G, Goyette N, Sergerie Y, Keays S, Booth T. Longitudinal evaluation of herpes simplex virus DNA load during episodes of herpes labialis. J Clin Virol. 2006 Dec. 37(4):248-51. [Medline].
Foti C, Filotico R, Calvario A, Conserva A, Antelmi A, Angelini G. Relapsing herpes simplex-2 folliculitis in the beard area. Eur J Dermatol. 2004 Nov-Dec. 14(6):421-3. [Medline].
Weinberg JM, Mysliwiec A, Turiansky GW, Redfield R, James WD. Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum. Arch Dermatol. 1997 Aug. 133(8):983-6. [Medline].
Kaufman HE, Azcuy AM, Varnell ED, Sloop GD, Thompson HW, Hill JM. HSV-1 DNA in tears and saliva of normal adults. Invest Ophthalmol Vis Sci. 2005 Jan. 46(1):241-7. [Medline].
Hull CM, Harmenberg J, Arlander E, Aoki F, Bring J, Darpö B, et al. Early treatment of cold sores with topical ME-609 decreases the frequency of ulcerative lesions: A randomized, double-blind, placebo-controlled, patient-initiated clinical trial. J Am Acad Dermatol. 2011 Apr. 64(4):696.e1-696.e11. [Medline].
[Guideline] Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [Medline].
Hosken NA. Development of a therapeutic vaccine for HSV-2. Vaccine. 2005 Mar 18. 23(17-18):2395-8. [Medline].
Stanberry LR, Spruance SL, Cunningham AL, Bernstein DI, Mindel A, Sacks S, et al. Glycoprotein-D-adjuvant vaccine to prevent genital herpes. N Engl J Med. 2002 Nov 21. 347(21):1652-61. [Medline].
Gupta R, Wald A, Krantz E, Selke S, Warren T, Vargas-Cortes M, et al. Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract. J Infect Dis. 2004 Oct 15. 190(8):1374-81Epub 2004 Sep 20. [Medline].
Mayaud P, Legoff J, Weiss HA, Grésenguet G, Nzambi K, Bouhlal H, et al. Impact of acyclovir on genital and plasma HIV-1 RNA, genital herpes simplex virus type 2 DNA, and ulcer healing among HIV-1-infected African women with herpes ulcers: a randomized placebo-controlled trial. J Infect Dis. 2009 Jul 15. 200(2):216-26. [Medline].
Nagot N, Ouedraogo A, Konate I, Weiss HA, Foulongne V, Defer MC, et al. Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels. J Infect Dis. 2008 Jul 15. 198(2):241-9. [Medline].
Ouedraogo A, Nagot N, Vergne L, Konate I, Weiss HA, Defer MC, et al. Impact of suppressive herpes therapy on genital HIV-1 RNA among women taking antiretroviral therapy: a randomized controlled trial. AIDS. 2006 Nov 28. 20(18):2305-13. [Medline].
Scott LL, Hollier LM, McIntire D, Sanchez PJ, Jackson GL, Wendel GD. Acyclovir suppression to prevent clinical recurrences at delivery after first episode genital herpes in pregnancy: an open-label trial. Infect Dis Obstet Gynecol. 2001. 9(2):75-80. [Medline].
Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA. 2010 Aug 25. 304(8):859-66. [Medline].
Barclay L. ACOG recommends expedited partner therapy for STIs. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845221. May 22, 2015; Accessed: June 24, 2015.
[Guideline] American College of Obstetricians and Gynecologists. Committee opinion no 632: expedited partner therapy in the management of gonorrhea and chlamydial infection. Obstet Gynecol. 2015 Jun. 125 (6):1526-8. [Medline].
Baeten JM, Strick LB, Lucchetti A, Whittington WL, Sanchez J, Coombs RW, et al. Herpes simplex virus (HSV)-suppressive therapy decreases plasma and genital HIV-1 levels in HSV-2/HIV-1 coinfected women: a randomized, placebo-controlled, cross-over trial. J Infect Dis. 2008 Dec 15. 198(12):1804-8. [Medline]. [Full Text].