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| Fig. 25.1 A, Classic lesion of recurrent herpes simplex with grouped vesicles on an erythematous base. B, Recurrent herpes genitalis. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
The clinical history of recurrent blisters or erosions in the same site (especially in an oral or genital distribution) is highly suspicious for HSV infection. A prodrome of tingling or burning is also consistent with this diagnosis. On physical exam, the classic lesion is grouped vesicles on an erythematous base (see Fig. 25-1A), but, more often, only nonspecific crusted erosions are seen. To confirm the diagnosis, laboratory assessment may be needed. The gold standard remains viral culture. However, use of many other rapid and sensitive techniques for detection of viral-specific proteins or nucleic acids is often available. For any method of detection, the age of the lesion sampled is critical. Vesicles are optimal but ulcers and erosions, if they are not dry and crusted, may also yield positive results.
