Herpes simplex virus

Immunologically, 2 types can be distinguished:

• Herpes simplex type 1 mainly causes lesions in the area of the lips and the oral mucosa. However, it is also increasingly found in genital herpes. Gingivostomatits herpetica is a classic HSV-1 infection.
• Herpes simplex type 2 is often responsible for lesions in the genital and gluteal areas. Transmission is most commonly through asymptomatic viral excretors (15-20% of HSV-2 infected individuals are asymptomatic viral excretors).

Biological functions:

• Neurovirulence: Ability to penetrate the blood-brain barrier and replicate in the CNS (possible development of herpes simplex encephalitis).
• Neurotoxicity: ability to destroy neurons in the brain.
• Latency: Persistence in neurons and latent infection in ganglion cells (HSV-1 persists predominantly in trigeminal ganglia; HSV-2 mostly in spinal ganglia S2-S5 or ganglia of the autonomic nervous system).
• Reactivation: recurrences of latent HSV infections.

Primary infections with HSV-2 are often asymptomatic.

Primary infections with HSV-1:

• In childhood often picture of gingivostomatitis herpetica.
• Rare: Aphthoid Pospischill-Feyrter
• Rarer: extensive herpetic phenomena on the face.

Secondary infections with HSV-1 and 2 as well as symptomatic initial infections: see below. herpes simplex virus infections.

Cultural cultivation of the virus from vesicle contents (gold standard; specific and safest but costly method).

In the Tzanck test from the base of the vesicle, detection of multinuclear, epidermal giant cells.

Electron microscopy: Virus detection from vesicle contents using the negative staining method (good method but not very relevant in practice).

Detection of HSV antigen with direct immunofluorescence or HSV-DNA (PCR).

Antibody detection (IgM and IgG) is only possible after 10-12 days (detection of IgM antibodies with subsequent increase in IgG titer indicates a fresh infection; recurrences can only be diagnosed insufficiently serologically, as there is usually no titer movement). The importance of serological diagnostics lies in the detection of seroconversion in primary infections!

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