Herpetic whitlow

This is a local painful presentation where a painful vesicle or pustule is found on a finger.

Type 2 HSV occurs as a primary infection due to sexual contact in young adults as acute vulvovaginitis, penile or perianal lesions sometimes with associated dysuria, difficulties in passing urine, fever, headache and muscle pains. Differential diagnosis
HSV may be confused with impetigo. The virus can be cultured or identified by immunofluorescence from a swab (Box 12. 2).

Box 12.2 Viral swab Use the appropriate medium; Pierce the roof of the blister and place swab in the fluid and rotate.     Source: RCN/BDNG (2008).

Complications
Complications are rare but serious (Gawkrodger, 2003). Secondary bacterial infection is usually due to S. aureus. Eczema herpeticum where eczema becomes infected with herpes simplex is a serious potentially fatal complication (Figure 12.3). Disseminated herpes simplex can occur in neonates or immunosuppressed patients. Chronic and atypical lesions can occur in patients with HIV. Herpes encephalitis is a serious complication. Lastly, infection with HSV is the most common cause of recurrent erythema multiforme (Gawkrodger, 2003).

Management

1. Mild HSV may not require any treatment. Those with more severe disease will require symptomatic treatment with oral fluids and paracetamol.
2. Recurrent or mild facial or genital HSV can be treated with aciclovir topically five times daily for 5 days. This helps to reduce the length of the attack and the duration of viral shedding if given early. Viral shedding occurs when the virus is active and transmittable. More severe episodes require oral aciclovir. Those with recurrent attacks may require prophylactic treatment with aciclovir.
3. Intravenous aciclovir may be needed for severe attacks in the immunosuppressed and those with eczema herpeticum.
4. Genital herpes can be treated with valaciclovir or famciclovir. Barrier contraception methods are advised during intercourse which ideally should be avoided while the patient is symptomatic.