• herpes simplex 1
• herpes simplex 2
• epstein barr virus
• varicella zoster
• cytomegalovirus
• human herpes virus 6,7,8

• large icosahedreal, double stranded DNA virus
• replicate in nucleus of cells
• enveloped with glycoprotein spikes
• tendency to develop latent infections
• most primary (initial) infections are asymptomatic - EXCEPT varicella zoster

contact w/ saliva or other secretions

half of kids infected by 10; 2/3 adults have antibodies

only 1/4 primary infections symptomatic (other 3/4 = reservoir for others to get infected)

• oral - symptomatic, asymptomatic
• genital - symptomatic, asymptomatic
• ocular - keratoconjunctivitis
• peripheral - ex. whitlow

• oral, ocular, genital, peripheral = all symptomatic and asymptomatic shedding

HSV-1 primary infection

- usually in children <6yrs

- incubation = 1 week

- intraoral lesions covered w/ gray-white plaque

- lesions involve lips, palate, tongue and gums

Recurrent HSV-1 infection

- usually along mucocutaneous junction of lips

- single or clustered

- trigger

- duration = 10-14 days

- treatment only in immune-compromised

genital tract

(however extragenital lesions do occur; babies also infected at time of delivery)

1. primary infection (symptomatic)
2. primary infection (asymptomatic)
3. recurrent infection (symptomatic)
4. reccurent infection (asymptomatic)

• Males: glans or shaft of penis
• females: vulvar, cervical or perianal

- HSV-2

(much more common with primary infection)

1/2 of babies born to mothers with active lesions are infected

neonatal infections clinical syndromes include:

• encephalitis
• disseminated multi-organ infection (liver, spleen, lungs)

• PCR (nucleic acid amplification)

• ACYCLOVIR
• acute primary genital infections: acyclovir or a "cousin"
• recurrent genital infection: prevented by prophylactic acyclovir
• can also be used to treat serious infection in immune-compromised

saliva of person shedding virus

- virus has affinity for receptors on surface B cells

- viral infection = local replication and secondary viremia (proliferation of B and T8 (suppressor) cells)

50% of 5yr olds are infected (children usually asymptomatic)

- second wave in teens

- by 40 yrs old, 90-95% have antibodies

• incubation = 4-6 weeks
• illness lasts 2-8 weeks
• fatigue persists longer

• tonsilar enlargement 
• pharyngeal redness w/ or w/o pus
• large liver + spleen
• skin rash esp after ampicillin
• cervical adenopathy

• increased lymph (atypical >30%) and monocytes
• neutropenia (low neutorphils) and thrombocytopenia (low platelets)
• elevated liver enzymes
• heterphile antibodies (cross react with sheep or horse rbc's); usually determined using Monospot; positive test is very specific (97%)

• virus spread worl dwide, occurs in lower socio-economic groups
• 2 peaks: 1. childhood; 2. early adulthood
• most adults sero-positive (appx 70% in Canada)

• perianal transmission (?? perinatal?)
• intrauterine, cervix at time of delivery, breast milk
• close contact (saliva)
• blood transfusions and organs
• sexual intercourse

• most asymptomatic 
• some get mononucleosis-like syndrome but heterophile antibody does not develop
• infections can be sever in fetus

• light microscope (inclusions and giant cells)
• serology (determine immunity)
• direct detection by EM or immunofluorescence
• virus isolation
• nucleic acid amplification

• usually not required
• antivirals (gancyclovir) usually used; immunoglobulin therapy reserved for immune compromised host