Herpes Simplex in Emergency Medicine Workup

  • Author: Rahul Sharma, MD, MBA, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Apr 27, 2011
 

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 herpes simplex virus (HSV) present.

  • Multinucleated giant cells, as shown in the image belowTzanck smear showing a multinucleated giant cell Tzanck smear showing a multinucleated giant cell
  • 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
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Imaging Studies

CT scan and MRI for differentiation of encephalitis from other entities

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Procedures

Slit-lamp examination for dendritic keratitis with ocular involvement

Lumbar puncture, if concerned about encephalitis

Brain biopsy, if encephalitis is considered

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Rahul Sharma, MD, MBA, FACEP  Assistant Professor, Weill Medical College of Cornell University; Assistant Director for Operations, Department of Emergency Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center

Rahul Sharma, MD, MBA, FACEP 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, MCP 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.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Weiss, MD  DTM&H, Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD 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.

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  Chair, Department of Emergency Medicine, LeConte 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.

References

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  3. Tronstein E, Johnston C, Huang ML, Selke S, Magaret A, Warren T, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. Apr 13 2011;305(14):1441-9. [Medline].

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

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

 
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Cutaneous vesicles characteristic of herpes simples virus infection
Herpes labialis
Penile infection with herpes simplex virus type 2
Tzanck smear showing a multinucleated giant cell
Herpes simplex virus dendritic ulcer with fluorescein staining.
Genital herpes infection
 
 
 
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