Patient Case: Herpes Simplex Virus (HSV) Infection
A 27-year-old woman presents to her primary care physician with a painful, burning sensation on her lower lip that started two days ago. She reports that the area initially felt tingly and itchy, but has since developed into small, fluid-filled blisters clustered near the corner of her mouth. The blisters are painful to touch and have begun to rupture, forming shallow ulcers.
She recalls experiencing similar episodes in the past, often triggered by stress, fatigue, or prolonged sun exposure. Her medical history is unremarkable, and she denies any recent fever or systemic symptoms. She has not been using any new skincare products and does not recall any allergic reactions.
On physical examination, a cluster of small vesicles on an erythematous base is noted on the right side of her lower lip. Some of the vesicles have ruptured, leaving crusted erosions. No lymphadenopathy is detected, and the rest of her exam is unremarkable.
Given the recurrent nature and classic appearance of the lesions, a diagnosis of herpes simplex virus (HSV-1) infection, also known as oral herpes or a cold sore, is made. The patient is offered antiviral treatment (acyclovir or valacyclovir) to shorten the duration of symptoms and is advised to avoid touching the lesions to prevent autoinoculation and transmission to others. She is also counseled on triggers and preventive measures, including the use of sunscreen on her lips and stress management.
- What is the most likely cause of this patient’s condition?
A) Herpes simplex virus type 1 (HSV-1)
B) Varicella-zoster virus (VZV)
C) Human papillomavirus (HPV)
D) Streptococcus pyogenes - Which of the following best describes the characteristic appearance of herpes simplex labialis (cold sores)?
A) Painful, fluid-filled vesicles on an erythematous base that rupture and crust
B) Pustules with surrounding erythema and honey-colored crusts
C) Thick, scaly plaques with silvery-white scales
D) Target-like lesions with central clearing - Which of the following factors is most commonly associated with reactivation of herpes simplex virus?
A) High blood sugar levels
B) Emotional stress, fatigue, or sun exposure
C) Poor dietary intake of vitamin C
D) Frequent handwashing - What is the best treatment approach for this patient?
A) Topical corticosteroids to reduce inflammation
B) Oral antiviral therapy (acyclovir or valacyclovir) to shorten symptom duration
C) Long-term antibiotic therapy to prevent bacterial superinfection
D) Immediate surgical excision of the lesion
Answers
- Answer: A) Herpes simplex virus type 1 (HSV-1)
- HSV-1 is the primary cause of oral herpes (cold sores), which presents as painful vesicles on the lips or around the mouth.
- Varicella-zoster virus (B) causes chickenpox and shingles, which follow a dermatomal distribution.
- HPV (C) is responsible for warts but does not cause vesicular lesions.
- Streptococcus pyogenes (D) causes bacterial infections like impetigo but not herpes labialis.
- Answer: A) Painful, fluid-filled vesicles on an erythematous base that rupture and crust
- HSV lesions typically start as vesicles on a red base, then rupture and form crusts before healing.
- Pustules with honey-colored crusts (B) are characteristic of impetigo.
- Thick, scaly plaques (C) suggest psoriasis.
- Target-like lesions (D) are seen in erythema multiforme, often associated with HSV but not the primary lesion of HSV itself.
- Answer: B) Emotional stress, fatigue, or sun exposure
- HSV-1 remains dormant in the trigeminal ganglia and can reactivate due to stress, fatigue, illness, or sun exposure.
- High blood sugar levels (A) are associated with diabetes but do not directly cause HSV reactivation.
- Poor vitamin C intake (C) may affect immune function but is not a known trigger for herpes reactivation.
- Frequent handwashing (D) is good hygiene practice but has no effect on HSV reactivation.
- Answer: B) Oral antiviral therapy (acyclovir or valacyclovir) to shorten symptom duration
- Antiviral therapy helps reduce the duration and severity of HSV outbreaks, especially if taken early.
- Topical corticosteroids (A) can worsen viral infections and are not recommended.
- Antibiotics (C) do not treat viral infections but may be needed if secondary bacterial infection occurs.
- Surgical excision (D) is not an appropriate treatment for HSV lesions.
