What is the prognosis of herpes simplex virus (HSV) infections?

Updated: Feb 27, 2019
  • Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD  more...
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Herpes simplex virus infections beyond the fetal and neonatal period are usually associated with increased morbidity but are not life threatening.

Herpes simplex virus encephalitis is a serious disease that can result in clinically significant neurologic impairment or death. The mortality rate is approximately 70% in untreated patients and 19% in treated patients. [19] Even after treatment, survivors have some neurologic impairment (impaired learning, dysnomia) noted upon detailed clinical cognitive testing.

Even with antiviral therapy, neonatal herpes simplex virus infection is associated with significant morbidity and mortality. Death typically does not occur after skin, eye, and mucus membrane (SEM) disease is treated, but 12-month mortality rates approach 4% with neonatal CNS disease and 29% with disseminated disease. Among neonates treated with antivirals, 2% of children with SEM disease, 69% of children with herpes simplex virus–related CNS disease, and 17% of children with disseminated herpes simplex virus disease develop evidence of neurologic impairment 2 years after infection. [19, 87]

The results of one study noted that infants who survived neonatal herpes simplex virus infection with CNS involvement who received suppressive therapy with oral acyclovir (300 mg/m2/dose PO tid for 6 mo) had significantly higher mean Bayley mental-development scores at 12 months than did infants who did not. [87] Another multicenter, retrospective, cohort study suggest that delayed initiation of acyclovir therapy was associated with significantly greater odds of death in neonates with herpes simplex virus infection. [76]

Genital herpes simplex virus infection may not be life threatening but is an important cause of physical and psychological morbidity.

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