Common “Dogma” and Evidence-Based Information Regarding HSV

No evidence or evidence refutes:
  • Oral ACV suppresses CNS recurrences

  • Genital HSV infection causes symptoms

  • HSV PCR of CSF can “rule out” HSV encephalitis

  • HSV in recurrent lesions can spread to other tissues

  • A traumatic LP can be used to evaluate HSV CNS disease

  • HSV encephalitis is associated with fever and systemic symptoms

Evidence supports:
  • No studies of ACV suppression of CNS recurrences have been completed

  • Most oral and genital HSV infections are asymptomatic or unrecognized

  • The sensitivity of HSV PCR for diagnosis of encephalitis is ∼70% early in the disease of adults and infants

  • After acute infection, immunity generally limits “spread” of HSV to other sites except perhaps within the nervous tissue

  • CSF pleocytosis may be low or not evident in early CNS disease; elevated neutrophils and protein may be early signs of CNS disease

  • Fever has been documented in ∼60% of cases

  • A better neurologic outcome is achieved when disease is diagnosed in asymptomatic infants