eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpes Simplex: Follow-up

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

Follow-up

Further Inpatient Care

  • Admission for patients with herpes simplex is necessary in the following instances:
    • Encephalitis
    • Severe gingivostomatitis causing decreased ability to tolerate oral fluids
    • Immunocompromised patients with severe or disseminated disease

Further Outpatient Care

  • Oral medication (see Medication): Topical acyclovir is only minimally helpful in patients with primary disease and is probably ineffective in recurrent episodes.
  • Burroughs Wellcome Co maintains a registry for monitoring outcome in pregnant women exposed to acyclovir; physicians should register patients at (800) 722-9292, extension 58465.

Deterrence/Prevention

  • HSV-2 is an STD. Patients and all sexual contacts should be tested and treated for accompanying STDs.
  • Practice abstinence when lesions are present.
  • Always use condoms because of the potential for asymptomatic viral shedding.
  • Health care personnel (especially medical, dental) should use universal precautions (eg, gloves) to prevent herpetic whitlow.
  • Experimental vaccines are currently in clinical trials.
  • Use sunscreen to decrease herpes labialis recurrences.

Complications

  • Encephalitis
    • Rare complication of herpetic infection
    • Commonly HSV-1 (hypothesized to spread to the brain via neural routes after primary or recurrent infection)
  • Neonatal infections
    • Range from mild localized infection to a fatal disseminated disease
    • HSV-2 usually spread via the maternal genital tract
    • Congenital infections possible
  • Compromised host - Progressive and disseminated disease possible
  • Genital infection - Acute urinary retention

Prognosis

  • High recurrence rate for genital HSV-2 infection
    • More than 85% of patients with one symptomatic episode will experience another.
    • Recurrences may be frequent; 38% of the population with genital herpes have more than 6 recurrences per year; 20% have more than 10 recurrences per year.

Patient Education

  • Antiviral therapy may decrease the clinical manifestations of the disease but does not cure it.
  • Initiate antiviral therapy as soon as possible after the patient notes symptoms.
  • Consider prophylaxis for patients who have more than 6 recurrences per year.
  • Educate patient that HSV-2 is an STD. Follow deterrence measures.
  • Referral to support groups: The American Social Health Association (ASHA) operates the National Herpes Hotline (919-361-8488), which provides educational materials and counseling for patients.
  • For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center and Teeth and Mouth Center. Also, see eMedicine's patient education articles Genital Herpes and Oral Herpes.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify active lesions at the time of labor and to perform cesarean section to decrease risk of transmission to the neonate
  • Failure to refer all contacts of patients with genital HSV-2 for follow-up
  • Failure to test, treat, and arrange counseling for associated STDs
  • Failure to treat disseminated disease aggressively in immunocompromised patients
  • Failure to diagnose herpetic keratoconjunctivitis in a patient who presents with a red eye
  • Failure to suspect and diagnose meningitis or encephalitis
  • Do not incise and drain herpetic whitlow

Special Concerns

  • Pregnancy and HSV disease
  • Neonate and HSV disease
  • Patients who are immunocompromised with HSV disease
 


More on Herpes Simplex

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

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Further Reading

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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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