Inflammation / parasites
Herpes simplex virus (HSV)

Topic Completed: 1 November 2010

Revised: 21 December 2018, last major update November 2010

Copyright: (c) 2006-2017, PathologyOutlines.com, Inc.

PubMed search: Cervix HSV

Farnaz Hasteh, M.D.
Branko Perunovic D.M.
Page views in 2019 to date: 13
Cite this page: Hasteh F., Perunovic B. Herpes simplex virus (HSV). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixHSV.html. Accessed December 12th, 2019.
Definition / general
  • Common disease caused by herpes simplex 1 (HSV1) or herpes virus simplex 2 (HSV2)
  • In one study, 3% (HSV1) and 8% (HSV2) of women visiting US physicians (J Clin Virol 2005;33:25)
  • Neonatal herpes may occur if infant is delivered vaginally during maternal genital herpes
  • HSV1 antibodies increase with age starting in childhood and correlate with socioeconomic status, race and cultural group; by age 30 years, 50% of individuals of high socioeconomic status and 80% of lower socioeconomic status are seropositive
  • HSV2 antibodies correlate with sexual activity, with a lifetime seroprevalence of 20% - 80% of population (eMedicine)
  • HSV2 was traditionally associated with genital tract infections but a recent study of college students shows 60% of genital herpes cases due to HSV1 (J Am Coll Health 2009;57:389)
Clinical features
  • Either asymptomatic or painful blisters initially; less severe symptoms in subsequent episodes
  • Cytology, in situ hybridization and PCR helpful for rapid diagnosis (Diagn Cytopathol 2003;29:246)
  • Liquid based pap tests may be more sensitive (Diagn Cytopathol 2008;36:94)
  • Virus can be dormant for long periods
  • Dangerous in pregnant women (may cause encephalitis in infants)
  • Antiviral medication decreases the duration of disease and prevents outbreaks; goal of pharmacotherapy is to reduce morbidity and prevent complications (eMedicine)
Microscopic (histologic) description
  • Epithelial ulcers with acute and chronic inflammatory cells, epithelial cell necrosis
  • Multinucleate cells with intranuclear inclusions that are smudged (ground glass) or discrete are usually at periphery of ulcer
  • Usually affects squamous cells not endocervical glandular epithelium
Cytology description
  • Early changes can include mono nucleated cells (DeMay: The Pap Test: Exfoliative Gynecologic Cytology; 2005)
  • Multinucleated cells with dense, intranuclear Cowdry type viral inclusions
  • Nuclei have ground glass appearance due to accumulation of viral particles, which causes peripheral margination of chromatin
  • Also nuclear molding
  • "Three M’s of herpes" - margination of nuclei, molding and multi nucleation
  • Cowdry: intranuclear eosinophilic amorphous or droplet - like bodies surrounded by a clear halo, with (type A, herpes) or without (type B, adenovirus or poliovirus) margination of chromatin on the nuclear membrane
  • Cowdry type A are highly characteristic but they are only seen in less than half of cases (Acta Cytol 1994;38:43)
Cytology images

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Electron microscopy description
  • Ground glass appearance is due to intranuclear viral particles
  • Enhancement of nuclear envelope is caused by peripheral chromatin margination
Differential diagnosis
  • Inflammatory cells with multiple nuclei (lack discrete nuclear molding)
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