Herpes simplex virus in Child
See also in: Cellulitis DDx,AnogenitalAlerts and Notices
Synopsis
HSV is highly contagious. It is spread by direct contact with virus-containing lesions or through contact with contaminated saliva or other body fluids during periods of viral shedding. The virus establishes lifelong latency in the dorsal root ganglia. Clinical disease occurs with reactivation (spontaneously or with trauma, UV exposure, fever, or immunosuppression) of the latent virus, which travels from the nerve root to innervated skin regions.
Primary infection denotes the initial inoculation episode, which may be subclinical or cause significant disease. Primary infections are more common in childhood. Symptoms of primary disease are usually more severe than recurrent disease and depend upon the site of inoculation.
- Orofacial herpes simplex infections (also known as cold sores, fever blisters, or herpetic gingivostomatitis) are very common viral infections causing pain, vesicles, ulceration, and crusting of the perioral skin and oral mucosa. The majority of primary infections are asymptomatic, occurring without any signs of cutaneous disease. Symptomatic eruptions may be highly localized to a small area or involve the entire oropharynx and lips. Severe oral ulcerations can develop and be associated with fever, pharyngitis, lymphadenopathy, malaise, headache, foul breath, and difficulty eating. The primary episode usually resolves within 14 days. However, viral shedding from intraoral lesions can persist for several weeks after clinical lesions have resolved.
- Genital herpes simplex is frequently seen in sexually active adolescents but can also occur in younger children. Symptoms develop within 5-10 days of initial contact. However, it is important to note that even when asymptomatic, a person sheds the virus and so can transmit the disease to another. In some adolescents, primary infection can be severe and include symptoms of aseptic meningitis such as fever, headache, stiff neck, and photophobia. In girls, there can be severe local symptoms of pain, dysuria, and vaginal discharge.
- Primary keratoconjunctivitis is associated with pain, eyelid edema, photophobia, and tearing. Localized adenopathy is common with primary infection. The disease occurs 3-7 days after exposure; recovery from a primary episode usually occurs in 2-6 weeks.
- Disseminated infection and pneumonitis may occur in the immunocompromised.
Recurrent disease describes reactivation episodes, which occur in 30%-50% of oral HSV and 95% of genital HSV infections. An individual may be coinfected with more than one type of HSV and in more than one location. HSV acquisition at a new site in a previously infected person is designated a nonprimary, first-episode infection.
Recurrent disease usually lacks constitutional symptoms. Itching, burning, or pain often precedes the skin lesions. Complications include bacterial superinfection, eczema herpeticum, erythema multiforme, Bell palsy, aseptic meningitis, and encephalitis.
Codes
ICD10CM:B00.1 – Herpesviral vesicular dermatitis
SNOMEDCT:
88594005 – Herpes simplex
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Orofacial:- Differentiate from zoster, which also presents with umbilicated vesicles.
- Molluscum contagiosum
- Fixed drug eruption
- Insect bites
- Candidiasis
- Contact dermatitis
- Herpangina
- Aphthous stomatitis
- Erythema multiforme
- Impetigo
- Oral erosive lichen planus
- Hand-foot-and-mouth disease
- Stomatitis associated with chemotherapy (see chemotherapy-induced mucositis)
- Stevens-Johnson syndrome
- Behçet syndrome
- Cellulitis / superinfected traumatic erosions
- Contact dermatitis
- Intertrigo
- Fixed drug eruption
- Molluscum contagiosum
- Insect bites
- Folliculitis
- Candidiasis
- Bullous impetigo
- Aphthous ulcers
- Behçet syndrome
- Consider herpes zoster if the lesions seem unilateral.
- Erosive lichen planus
- Fournier or gas gangrene
- Pyoderma gangrenosum
- Ecthyma gangrenosum
- Sexual abuse
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Management Pearls
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Therapy
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References
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Last Reviewed:12/14/2016
Last Updated:04/28/2019
Last Updated:04/28/2019
Patient Information for Herpes simplex virus in Child
Overview
Herpes simplex virus (HSV) is a common infection that can cause skin or mouth sores, the latter of which are often called cold sores or fever blisters. The first eruption, or outbreak, is called primary herpes. This is often more severe than secondary, or recurrent, herpes infections.Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) can cause infection. HSV-1 is the most common cause of lesions that appear around the mouth and on the lips. HSV-2 more commonly causes lesions on the genital area, although HSV-1 can also be a cause. HSV-2 can more rarely occur on virtually any body surface. HSV is highly contagious and is spread by direct contact with the lesions of another infected individual, such as a playmate, parent, or caretaker. The virus can even spread in the absence of symptoms or visible lesions.
The primary herpes episode usually heals in 7-10 days. Affected individuals carry the virus in their bodies for the rest of their lives, and this may lead to recurrences of outbreaks in the same skin area. Most people report burning, itching, and a tingling sensation in the area before the actual lesions appear.
Who’s At Risk
Infection with HSV is very common. Most people never even know they have been infected, as their immune system suppresses symptoms. At least one-third of children are infected by HSV by the end of childhood.HSV infection may be more severe in newborns and in those with a weak immune system.
Signs & Symptoms
Most commonly, primary herpes in children involves painful blisters and erosions of the gums and the skin around or lining the mouth. There may also be fever, swollen lymph nodes in the neck, irritability, and a poor appetite. If HSV is introduced on other body sites, there may be painful blisters and sores in that location (eg, the finger, face, genitals), with swelling and similar symptoms affecting the entire body, such as fever and swollen lymph nodes.Self-Care Guidelines
- You can give acetaminophen (Tylenol) or ibuprofen (Advil, Motril) for the pain. It is important to relieve pain so that eating and sleeping are possible.
- The child should be encouraged to drink as much fluid as possible to avoid dehydration.
- Avoid contact with other children, especially newborns and those with eczema or a weak immune system, until healed.
When to Seek Medical Care
Although those with mild recurrent herpes do not usually require any medical care, see your child's medical professional if you think they have primary herpes or if your child has recurrent herpes with bothersome symptoms.Treatments
Antiviral medications may be prescribed, including acyclovir (Zovirax) or valacyclovir (Valtrex; only in children ages 12 years and older). Anesthetic mouthwashes or pain medication may be given to reduce pain. Sometimes a child will need to be given intravenous fluids for dehydration.Herpes simplex virus in Child
See also in: Cellulitis DDx,Anogenital