Penis & scrotum
Infectious
Herpes simplex virus
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Last author update: 1 February 2010
Last staff update: 14 August 2023 (update in progress)
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Herpes simplex virus penis
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Diagrams / tables | Clinical features | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Electron microscopy imagesCite this page: Chaux A, Cubilla AL. Herpes simplex virus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumHSV.html. Accessed September 28th, 2023.
Definition / general
- Sexually transmitted disease, usually caused by herpes simplex virus 2 (HSV2) and HSV1, which are DNA viruses (eMedicine: Herpes Simplex [Accessed 29 March 2018])
Terminology
- Herpesviridae family has at least 8 viruses known to infect man: HSV1, HSV2, Epstein-Barr virus (EBV), cytomegalovirus (CMV), varicella zoster virus (VZV), Human herpesvirus 6 (exanthum subitum or roseola infantum), Human herpesvirus 7 and Human herpesvirus 8 (Kaposi sarcoma associated herpesvirus)
Epidemiology
- Sexually transmitted; spreads by direct contact with lesions
- Also spreads by asymptomatic shedding when no lesion is apparent
Sites
- Genital region, mouth; also other areas
Etiology
- Although historically caused mainly by HSV2, now 5 - 30% of primary outbreaks of genital herpes are caused by HSV1
- Blisters contain large number of viral particles and are very contagious
Diagrams / tables
Images hosted on other servers:
Herpesvirus structure
Clinical features
- HSV infection is the most common cause of genital ulceration (BJU Int 2002;90:498)
- Multiple (6 - 10) small (1 - 2 mm) papules and macules, followed by vesicles that rupture and cause painful ulcers, usually at tip of penis or on shaft
- Atypical presentations include fissures, furuncles, linear excoriations and ulcerations
- In immunocompromised patients, especially those HIV positive, ulcerations can be deep and persistent
- Blisters occur around anus in men who have sex with men
- Usually diagnosed clinically, with confirmation by culture, direct fluorescent antibody, skin biopsy and PCR for viral DNA
- Primary outbreak: occurs 3 - 14 days after exposure; patients usually asymptomatic but rarely have systemic symptoms of fever, headache, muscle ache, fatigue, swollen and tender lymph nodes
- After infection, viral genome remains in latent state in nuclei of sensory neurons for life
- Recurrences: may not occur at all or up to 40 years after primary outbreak and usually milder than initial outbreak
Treatment
- Antiviral drugs reduce frequency, duration and severity of outbreaks and asymptomatic shedding
- Antiviral medications include aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir) and penciclovir (Wikipedia: Herpes Simplex [Accessed 29 March 2018])
Clinical images
Images hosted on other servers:
Multiple vesicles and ulcerations on surface
Microscopic (histologic) description
- Multinucleated giant cells with ground glass nuclei due to intranuclear virus
- More common at interface between ulcerated and nonulcerated areas
- Intraepithelial vesicles contain rounded acantholytic keratinocytes
- Keratinocytes show viral cytopathic changes of ground glass nuclei, nuclear molding and multinucleated giant epithelial cells
- Well defined acidophilic inclusions can also be seen
Microscopic (histologic) images
Images hosted on other servers:
Multinucleated giant cells with inclusions (right - vulva)
Positive stains
- HSV1 or HSV2
Electron microscopy images
Images hosted on other servers:
Negative stain
"Fried egg" appearance
