Snapshot A 27-year-old G3P0A2 presents to the outpatient clinic at 15 weeks' gestation and complains of exquisite vulvular pain and blisters. She reports that she has experienced several similar episodes for the past 5 years. On examination, you find multiple, painful vesicles on her left labia minora. You recall that she had a positive chlamydial culture on her first prenatal visit that was treated with erythromycin tablets. Introduction Herpes simplex virus is an infectious pathogen that presents in two distinct subtypes login to view 2 more bullets TORCH infection (Toxoplasmosis, Other [Syphilis], Rubella, CMV, and Herpes) Can result in significantly adverse effects on the fetus, neonate, or both login to view 2 more bullets Primary infection transmitted by direct contact Spreads via epidermal cells that fuse forming "multinucleated giant cells" Virus remains dormant in local nerves login to view 2 more bullets Symptomatic HSV infection for > 1 month may be considered an AIDS-defining illness Epidemiology Common in young adults who do not practice safe sex If mother has active vaginal infection, child has 50% chance of transmission Presentation Symptoms login to view 9 more bullets Physical exam login to view 22 more bullets STUDIES Tzanck smear login to view 2 more bullets Viral culture login to view 1 more bullet Antibody staining login to view 1 more bullet Differential Varicella zoster virus, other TORCH infections DIAGNOSIS Diagnosis is based primarily on clinica observations and patient history Treatment Prevention login to view 3 more bullets Medical management login to view 10 more bullets Complications Recurrence is expected, lesions can cause psychological/social anxiety in patients Prognosis Very good to excellent in healthy adults Outcomes in infants born with herpes vary widely according to symptoms