Genital Herpes Simplex Virus Type 1: Case Report of Oro-genital Infection by Autotransmission
Introduction: Herpes simplex virus type 1 (HSV-1) is most commonly transmitted during childhood via nonsexual contacts and is related to oral herpes, while herpes simplex virus type 2 (HSV-2) is usually transmitted through sexual contact and implies genital lesions. HSV-1, however, can also cause genital herpes. We present the unusual case of oral-genital spread of a primary HSV-1 infection in a young patient who had not initiated sexual activity. Case: A 13-year-old female patient presented to the emergency department for a painful lesion on the chin, suggestive of herpes infection. Topical acyclovir and oral antibiotic treatment were initiated. Forty-eight hours later she returned for intense vulvar pain associated with multiple vulvar ulcers and bilateral inguinal lymph nodes. PCR results for genital ulcer exudate and blood IgM were positive for HSV-1. As the patient had no history of sexual activity, the primary facial HSV-1 infection was considered most likely to have spread to the genital area via autotransmission. Discussion: Differential diagnosis of genital ulcers includes sexually transmitted diseases and non-infectious diseases. In the former group, the most common cause is HSV-2. Oro-genital spread of herpes infections through sexual contact as a route of transmission is not uncommon. The patient in the present report, however, denied having engaged in sexual activity of any type at any time. We thus consider that this unusual case highlights the autotransmission of an oral HSV-1 genital herpes infection to the genital area. Conclusion: The possibility of autotransmission of HSV-1 infection by skin contact from the facial region to the genital area can be overlooked. Prophylactic measures should be taken to avoid the spread of lesions to other locations, particularly the genital area.