eMedicine Specialties > Emergency Medicine > Infectious Diseases
Herpes Simplex: Differential Diagnoses & Workup
Updated: Sep 4, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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 |
| « Previous Page | Next Page » |
References
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].
Clark JL, Tatum NO, Noble SL. Management of genital herpes. Am Fam Physician. Jan 1995;51(1):175-82, 187-8. [Medline].
Cockerell C. Diagnosis and treatment of cutaneous herpes simplex virus infections. West J Med. Jun 1996;164(6):518-20. [Medline].
Frenkl TL, Potts J. Sexually transmitted infections. Urol Clin North Am. Feb 2008;35(1):33-46; vi. [Medline].
Hill J, Roberts S. Herpes simplex virus in pregnancy: new concepts in prevention and management. Clin Perinatol. Sep 2005;32(3):657-70. [Medline].
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.
Holland-Hall C. Sexually transmitted infections: screening, syndromes, and symptoms. Prim Care. Jun 2006;33(2):433-54. [Medline].
Johnson R. Herpes gladiatorum and other skin diseases. Clin Sports Med. Jul 2004;23(3):473-84, x. [Medline].
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].
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].
Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med. Sep 10 1992;327(11):782-9. [Medline].
Wu JJ, Pang KR, Huang DB. Advances in antiviral therapy. Dermatol Clin. Apr 2005;23(2):313-22. [Medline].
Further Reading
Keywords
herpes simplex, herpes virus, HSV-1, HSV-2, oral lesions, genital lesions, gingivostomatitis, herpes labialis, keratoconjunctivitis, corneal ulcer, corneal blindness,encephalitis, genital disease, newborn infection, neonatal HSV, trigeminal ganglia, sacral ganglia, sexually transmitted disease, STD, herpetic whitlow, herpes gladiatorum, herpetic diseases, Bell palsy, inguinal adenopathy, maternal-fetal transmission
Differential Diagnoses & Workup: Herpes Simplex