Case Report
Adolescent Primary Genital Herpes Simplex Virus Type 1 Infection with Sepsis Secondary to Streptococcus pyogenes Bacteremia

https://doi.org/10.1016/j.jpag.2021.07.001Get rights and content

Abstract

Background

Adolescents and young adults are responsible for most new genital herpes virus infections. Historically, primary genital herpes infections were thought to be caused by herpes simplex virus (HSV) type 2, however, recent studies suggest that up to 50% of incident episodes of genital herpes are caused by HSV type 1.

Case

In this case report we present an 18-year-old G1P0010 female who presented with a primary genital HSV type 1 outbreak that resulted in sepsis secondary to Streptococcus pyogenes bacteremia.

Summary and Conclusion

Complications that might arise from HSV include encephalitis, Bell's palsy, aseptic meningitis, hepatitis, pneumonitis, sacral radiculitis, viremia, and superimposed bacterial infections. HSV infections are rarely associated with these complications; however, physicians should be aware of sepsis secondary to bacteremia as a possible complication of primary genital HSV infections when treating immunocompetent adolescents.

Introduction

The Herpesviridae family encompasses a large family of viruses, with 8 species known to routinely infect humans. Of these 8 viral species, there are 2 types known to cause common oral and genital lesions: herpes simplex virus (HSV) type 1 (HSV-1) and HSV type 2 (HSV-2). Adolescents and young adults are responsible for most new genital herpes cases.1 Recent studies suggest that up to 50% of incident episodes of genital herpes are caused by HSV-1,2 information that is challenging the popularly held belief that HSV-2 is the predominant cause of genital herpes. The reason for the increase in incidence of genital HSV-1 cases is not clear but decreased HSV-1 infection in childhood and an increased practice of oral-genital sex during adolescence might be partially responsible.2 HSV-1 and HSV-2 seroprevalence studies conducted in the United States reveal that 53.1% of female adolescents aged 12-23 years and 49.4% of male adolescents aged 12-25 years are seropositive for HSV-1, whereas 15% of female adolescents and 12% of male adolescents are seropositive for HSV-2.3 For this case report we focus on HSV-1.

HSVs have the ability to invade and replicate in the host nervous system and establish a site of latent infection. Transmission of HSV-1 occurs when an individual comes into contact with herpetic-infected tissue or secretions. This typically occurs by either oral-oral, oral-genital, genital-genital, or genital-anal contact. Transmission does not only occur during active infection, but HSV-1 can be transmitted during episodes of asymptomatic viral shedding.2,3 In one retrospective study only 43% of patients who tested positive for HSV-1 antibodies reported having a history of oral-labial lesions, making asymptomatic viral shedding via oral-genital transmission an increasing concern for the acquisition of genital herpes.4 Asymptomatic transmission is an important consideration for the adolescent population, especially because adolescents explore various types of sexual activity and might be under the false assumption that avoiding certain types of sexual activity eliminates the risk of sexually transmitted infections (STIs).3

Although complications from HSV-1 infection are rare, those that have been documented include encephalitis, Bell's palsy, aseptic meningitis, hepatitis, pneumonitis, sacral radiculitis, and sepsis. Disseminated HSV occurs infrequently in people who are immunocompetent and can cause severe morbidity when it does occur.2 Streptococcus pyogenes is a pathogen that commonly colonizes the skin and can lead to infection if introduced into the body via a disruption in the epithelial barrier. This case presents a patient who presented with primary HSV-1 genital outbreak that resulted in sepsis secondary to S pyogenes bacteremia.

Section snippets

Case

The patient was an 18-year-old G1P0010 female adolescent with no previous history of STIs and 1 sexual partner with no known history of STIs or current symptoms. The patient was referred to the emergency department (ED) after a second urgent care evaluation in 5 days for worsening genital swelling and pain. From the urgent care evaluations, the patient had received medications for a presumed vaginal candidiasis bacterial vaginosis, and a urinary tract infection (medications included

Summary and Conclusion

HSV-1 in adolescents is typically associated with orolabial herpes, herpetic stomatitis, or herpetic whitlow; however, it is now associated with an increasing proportion of genital herpes infections. Extragenital complications from HSV-1 infection include encephalitis, Bell's palsy, aseptic meningitis, hepatitis, pneumonitis, sacral radiculitis, and sepsis secondary to viremia.2 Sepsis secondary to bacteremia in association with an HSV-1 infection has been reported in an immunocompromised

References (8)

  • BA Auslander et al.

    Genital herpes in adolescents

    Semin Pediatr Infect Dis

    (2005)
  • C Roberts

    Genital herpes in young adults: changing sexual behaviours, epidemiology and management

    Herpes

    (2005)
  • A Wald et al.

    Persistence in the population: epidemiology, transmission

  • L Oliver et al.

    Seroprevalence of herpes simplex virus infections in a family medicine clinic

    Arch Fam Med

    (1995)
There are more references available in the full text version of this article.

Cited by (0)

The authors indicate no conflicts of interest.

View full text