Clinical spectrum of herpes simplex virus infections

Treatment of mucocutaneous presentations of herpes simplex virus infections

Infections by herpes simplex virus (HSV) types I and II are diverse and quite frequent. After primary infection, the virus establishes a life-long latency in the sensory ganglia and recrudescences may occur at an unpredictable rate. Recurrent labial and genital herpes infections represent the majority of clinical manifestations of HSV infections. Their management is currently well established using evidence-based medicine data. Primary labial herpes is generally not treated with antivirals in otherwise healthy children, although intravenous aciclovir may be offered in severe primary infections, particularly in the immunocompromised patient. The decision whether or not to treat recurrent labial herpes should be evaluated individually and depends on the frequency and severity of relapses, the impairment of the quality of life, and the cost of therapy. Patients with mild disease may benefit from topical therapy, and those with severe and frequent recurrences may be considered for intermittent or long-term oral antiviral therapy. Primary genital herpes is treated with oral or intravenous antivirals, depending on the severity of the infection and associated symptoms. Recurrent genital herpes can be managed with episodic short courses of oral antivirals in patients whose recurrences are moderate to severe and rare, and have a clear prodrome. Patients with >5 episodes/year, severe recurrences or unrecognisable prodromes may be best managed with long-term suppressive antiviral prophylaxis. HSV is also responsible for a variety of other clinical manifestations, including herpetic whitlow, neonatal infection, disseminated and atypical cutaneous infections, traumatic herpes, eczema herpeticum, and HSV-associated erythema multiforme. HSV infection may also represent a complication following cosmetic procedures of the oro-facial region, surgical and dental interventions, sun exposure and burns. Precise treatment guidelines for these HSV infections are not firmly established.

Mucocutaneous herpetic infections during cancer chemotherapy

Adults who are given immunosuppressive and myelosuppressive cancer chemotherapy have a heightened risk for development of herpetic infections during treatment. The impact is much greater in patients who are given antineoplastic drugs for leukemia and lymphoma than in those who are given such drugs for carcinoma and sarcoma. In the series reported here, the incidence of herpes simplex infections exceeded that of herpes zoster infections in patients treated for leukemia by a ratio of more than 12:1, compared to slightly more than 2:1 in patients treated for solid tumor. The frequency of herpes simplex and herpes zoster infections during treatment for leukemia was 25%. Corresponding frequencies for patients with lymphoma, carcinoma, and sarcoma were 28%, 8%, and 3%, respectively.