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| Fig. 25.1 A, Classic lesion of recurrent herpes simplex with grouped vesicles on an erythematous base. B, Recurrent herpes genitalis. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
Recurrent HSV infection represents reactivation of the latent virus in the sensory ganglia. “Reactivated” virus particles migrate along the nerves to the site in the skin where the primary infection occurred, with subsequent viral replication and the development of clinical lesions (Fig. 25-1A). The most common sites for recurrent herpes simplex infection are the lips (herpes labialis, “cold sores”), genitalia (herpes genitalis), and sacral area (Fig. 25-1B). Often, individuals experience a prodrome of tingling or burning in the skin prior to the development of visible lesions. Certain factors, such as fever, stress, menses, and sun exposure, may precipitate recurrent infection. The frequency of recurrent infection varies greatly between individuals. In most individuals, clinically evident recurrence becomes less frequent over time.
