As discussed earlier, both HSV-1 and HSV-2 can cause genital or oral infection, and both produce indistinguishable primary or recurrent mucocutaneous lesions. Primary infection with HSV-2 often may be asymptomatic or may produce a variety of signs and symptoms. Locally painful vesicular lesions may be accompanied by dysuria, urethral discharge, local lymph node enlargement and tenderness, http://ebooksmedicine.net and systemic manifestations, such as fever, muscle aches, and headache. HSV is actively shed during this period, and shedding continues until the mucosal lesions have completely healed. However, asymptomatic viral shedding can occur as long as 3 months after diagnosis. Signs and symptoms may last for several weeks during the primary phase of disease. Recurrences are milder and of shorter duration than in the primary episode. Diagnosis is most often made by viral culture or nucleic acid amplification testing of fluid collected after “unroofing” of a vesicular lesion.
In immunocompetent adults, herpes genitalis generally is not life-threatening. However, HSV poses a major threat to immunosuppressed patients, in whom fatal, disseminated disease may develop. Also life-threatening is neonatal herpes infection, which occurs in about one-half of infants delivered vaginally of mothers suffering from either primary or recurrent genital HSV infection. The viral infection is acquired during passage through the birth canal. Its incidence has risen in parallel with the rise in genital HSV infection. The manifestations of neonatal herpes vary from involvement of superficial sites (skin, eyes and mouth) to involvement of the CNS, with or without disseminated infection of other organs such as the liver and lungs. Approximately 60% of affected infants die of the disease, with significant morbidity occurring in about one-half of the survivors. PCR-based testing is far more sensitive and the preferred method for diagnosis of encephalitis.
HPV causes a number of squamous proliferations in the genital tract, including condyloma acuminatum, as well as several precancerous lesions that commonly undergo transformation to carcinomas. The latter most commonly involve the cervix (Chapter 19), but also occur in the penis, vulva, oropharyngeal tonsil, and conjunctiva. Condylomata acuminata, also known as venereal warts, are caused by HPV types 6 and 11. These lesions occur on the penis as well as on the female genitalia. They should not be confused with the condylomata lata of secondary syphilis. Genital HPV infection may be transmitted to neonates during vaginal delivery. Recurrent and potentially life-threatening papillomas of the upper respiratory tract may develop subsequently in affected infants.
MORPHOLOGYInmales,condylomataacuminatausuallyoccuronthecoronalsulcusorinnersurfaceoftheprepuce,wheretheyrangeinsizefromsmall,sessilelesionstolarge,papillaryproliferationsmeasuringseveralcentimetersindiameter.Infemales,theycommonlyoccuronthevulva.ExamplesofthemicroscopicappearanceoftheselesionsarepresentedinChapter19.
•HSV-2and,lesscommonly,HSV-1cancausegenitalinfections.Initial(primary)infectionmaybeasymptomaticorcause painful,erythematous,intraepithelialvesiclesonthemucosaandskinofexternalgenitalia,alongwithpainfulregionallymphnodeenlargement.Recurrentlesionsingeneralarelesspainfulandlessextensivethanprimarylesions.
Onhistologicexamination,thevesiclesofHSVinfectioncontainnecroticcellsandfusedmultinucleategiantcellswithintranuclearinclusions(CowdrytypeA)thatstainwithantibodiestothevirus.