Herpes simplex virus type 1 (HSV-1) is a leading cause of skin infection in children. Because the disease has a rapid course and confirmatory laboratory tests may take more than 24 hours, a presumptive diagnosis should be made clinically to provide prompt intervention and prevent transmission. Regrettably, the diagnosis is missed in more than 50% of HSV cases. (1,2) A high index of suspicion by the primary care clinician is needed to increase the rate of clinical diagnosis. This article summarizes the clinical features, diagnostic tests, and recommended treatment of HSV-1 infections in children.
HSV-1, one of eight closely related human herpes viruses (see "The creepy herpesvirus family" on page 46), is among the most common infectious agents in humans. Infection with HSV-1 usually results from direct contact with infected oral secretions, skin lesions, or mucous membrane lesions of an infected person, who may or may not be symptomatic. Airborne transmission by aerosolized droplets or desquamated skin cells is also possible. The incubation period for HSV infections ranges from two to 14 days. (3) While nearly two thirds of primary infections in adults are symptomatic, only one third of primary infections in children are reported to be symptomatic, with the greatest concentration of virus shed during these infections. (4,5) Patients with primary HSV-1 infections may shed virus for one week or as long as several weeks.
HSV-1 infections are endemic worldwide, affecting nearly 75% of the general population at some time during life. (6) In the United States, the prevalence of HSV-1 infection tends to increase in a roughly linear fashion with increasing age, with the greatest rate of acquisition occurring during childhood and adolescence. (7) The prevalence of HSV-1 reaches more than 40% by age 15 years and rises to 60% to 90% in older adults. Recent data from several European countries show the prevalence of HSV-1 infection has dropped from 34% to 24% among 10- to 14-year-olds in the last decade. (8) For many adolescents and adults in Europe and the United States, sexual activity is the means of initial exposure, resulting in an increase in genital herpes infections caused by HSV-1. A multicenter study done in the US showed that the number of new genital HSV-1 infections occurred at the same rate as new oral HSV-1 infections among young adults. (4)
HSV-1 infection has no seasonal, racial, or geographic predilection. (9) However, any condition that increases human contact, such as attendance at a child-care center or having multiple sexual partners, increases the risk of acquisition.
Herpes simplex virus infections can occur on any skin surface and are not isolated to mucous membranes. A variety of clinical manifestations can result from HSV-1, including gingivostomatitis, herpetic whitlow, eczema herpeticum, genital herpes, and herpetic conjunctivitis. Whether primary or recurrent, HSV infections share common clinical features (Table 1). The lesions tend to heal without scarring, and recurrent disease usually occurs at the site of primary infection. Any blistering eruption that recurs at the same site should raise suspicion...
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