eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpes Simplex: Differential Diagnoses & Workup

Author: Rahul Sharma, MD, MBA, Instructor in Medicine, Weill Medical College of Cornell University; Consulting Staff, Department of Emergency Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center
Coauthor(s): Lawrence C Brilliant, MD, Clinical Assistant Professor, Department of Primary Care and Community Services, Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital
Contributor Information and Disclosures

Updated: Sep 4, 2008

Differential Diagnoses

Chancroid
Pharyngitis
Erythema Multiforme
Proctitis
Herpes Zoster
Syphilis
Pediatrics, Hand-Foot-and-Mouth Disease
Urethritis, Male
Pediatrics, Meningitis and Encephalitis
Pediatrics, Pharyngitis

Other Problems to Be Considered

Aphthous stomatitis

Workup

Laboratory Studies

  • Scrapings from suspected lesions of herpes simplex (Tzanck smear). This is not a reliable screening test, with a reported sensitivity of 65%. It also does not identify the type of HSV present.
    • Multinucleated giant cells (see Media file 4)
    • Intranuclear inclusions
  • Viral culture from skin vesicles (more sensitive that Tzanck smear but dependent on duration of viral shedding)
  • Monoclonal antibody testing
  • Serology
  • Cerebrospinal fluid (CSF) analysis for lymphocytic pleocytosis
    • Bloody CSF
    • Polymerase chain reaction (PCR) detects HSV DNA

Imaging Studies

  • CT scan and MRI for differentiation of encephalitis from other entities

Procedures

  • Slit-lamp examination for dendritic keratitis with ocular involvement
  • Lumbar puncture, if concerned about encephalitis
  • Brain biopsy, if encephalitis is considered

More on Herpes Simplex

Overview: Herpes Simplex
Differential Diagnoses & Workup: Herpes Simplex
Treatment & Medication: Herpes Simplex
Follow-up: Herpes Simplex
Multimedia: Herpes Simplex
References

References

  1. Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. Dec 1 1994;121(11):847-54. [Medline].

  2. Clark JL, Tatum NO, Noble SL. Management of genital herpes. Am Fam Physician. Jan 1995;51(1):175-82, 187-8. [Medline].

  3. Cockerell C. Diagnosis and treatment of cutaneous herpes simplex virus infections. West J Med. Jun 1996;164(6):518-20. [Medline].

  4. Frenkl TL, Potts J. Sexually transmitted infections. Urol Clin North Am. Feb 2008;35(1):33-46; vi. [Medline].

  5. Hill J, Roberts S. Herpes simplex virus in pregnancy: new concepts in prevention and management. Clin Perinatol. Sep 2005;32(3):657-70. [Medline].

  6. Hirsch MS. Herpes simplex virus. In: Mandell GL, ed. Mandell, Douglas, and Bennet's Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995:1336-45.

  7. Holland-Hall C. Sexually transmitted infections: screening, syndromes, and symptoms. Prim Care. Jun 2006;33(2):433-54. [Medline].

  8. Johnson R. Herpes gladiatorum and other skin diseases. Clin Sports Med. Jul 2004;23(3):473-84, x. [Medline].

  9. Patel R, Rompalo A. Managing patients with genital herpes and their sexual partners. Infect Dis Clin North Am. Jun 2005;19(2):427-38, x. [Medline].

  10. Rooney JF, Straus SE, Mannix ML. Oral acyclovir to suppress frequently recurrent herpes labialis. A double-blind, placebo-controlled trial. Ann Intern Med. Feb 15 1993;118(4):268-72. [Medline].

  11. Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med. Sep 10 1992;327(11):782-9. [Medline].

  12. Wu JJ, Pang KR, Huang DB. Advances in antiviral therapy. Dermatol Clin. Apr 2005;23(2):313-22. [Medline].

Further Reading

Contributor Information and Disclosures

Author

Rahul Sharma, MD, MBA, Instructor in Medicine, Weill Medical College of Cornell University; Consulting Staff, Department of Emergency Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center
Rahul Sharma, MD, MBA is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence C Brilliant, MD, Clinical Assistant Professor, Department of Primary Care and Community Services, Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital
Lawrence C Brilliant, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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