The Clinical Spectrum of Herpes Simplex Viremia

The vast majority of herpes simplex virus (HSV) infections in adults are relatively benign in their clinical manifestations. However, this ubiquitous virus clearly produces a diverse spectrum of disease. Although mucocutaneous HSV infection and reactivation can be associated with more generalized symptoms, the presence of viremia had previously been considered a rare occurrence. In the mid-1900s, HSV was isolated from the blood of an immunocompetent child with herpetic rhinitis [1], signaling the possibility of more widespread infection in clinically benign disease. Subsequently, though, sensitive HSV culture techniques were unable to identify viremia in immunocompetent pediatric patients with clinical HSV infection [2]; studies of blood cultures for HSV in immunocompetent adults have not been published. More recently, highly sensitive polymerase chain reaction (PCR) assays have altered our understanding of the natural history of HSV infection. HSV DNA has been found in the blood in 34% of children with primary gingivostomatitis [3], in 24% of adults with primary genital