Genital and perianal ulcers seen in patients with HIV are commonly due to herpes simplex virus (HSV) infection. While it is well known that the characteristic presentation of HSV is a vesicular rash or crops of erosions, the clinical presentation of genital HSV infection in HIV is varied and can assume vegetative, hypertrophic, condyloma-like, nodular, ulcerative and tumour-like nodules or plaques. These unusual presentations often lead to a delayed diagnosis. We describe five immunocompromised HIV-positive patients with CD4 counts ranging from 114 to 326 cells/μL with unusual presentations of anogenital herpes.
FrenchMA, LenzoN, JohnM, Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy. HIV Med2000;1:107–15
2.
FoxPA, BartonSE, FrancisN, Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease. HIV Med1999;1:10–8
MosunjacM, ParkJ, YunFW, Genital and perianal herpes simplex simulating neoplasia in patients with AIDS. AIDS Patient Care STDs2009;23:153–9
5.
HusakR, TebbeB, GoerdtS, Pseudotumour of the tongue caused by herpes simplex virus type 2 in an immunosuppressed patient. Br J Dermatol1998;139:118–21
6.
MyintM, OddenK, SchreursO, HalstensenTS, SchenckK. The gingival plasma cell infiltrate in HIV-positive patients with peridontitis is disorganized. J Clin Periodontol1999;26:358–65
7.
FoxPA, BartonSE, FrancisN, Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease. HIV Med1999;1:10–8
SchomogyiM, WaldA, CoreyL. Herpes simplex virus-2 infection. An emerging disease?Infect Dis Clin North Am1998;12:47–61
10.
SafrinS, AshleyR, HoulihanC, CusickPS, MillsJ. Clinical and serologic features of herpes simplex virus infection in patients with AIDS. AIDS1991;5:1107–10
11.
Kortekangas-SavolainenO, VuorinenT. Trends in herpes simplex virus type 1 and 2 infections among patients diagnosed with genital herpes in a Finnish sexually transmitted disease clinic, 1994–2002. Sex Transm Dis2007;34:37–40
12.
Alonso PerezA, FragaJ, DelgadoY, Nodular herpes zoster with herpetic syringitis and no epidermal involvement in a patient with Burkitt lymphoma. Am J Dermatopathol2006;28:194–96
13.
CarrascoDA, TriznaZ, Colome-GrimmerM, TyringSK. Verrucous herpes of the scrotum in a human immunodeficiency virus positive man:Case report and review of the literature. J Eur Acad Dermatol Venereol2002;16:511–5
NadalSR, CaloreEE, ManzioneCR, Hypertrophic herpes simplex simulating anal neoplasia in AIDS patients: Report of five cases. Dis Colon Rectum2005;48:2289–93
16.
BoothbyM, RadcliffeK. An unusual vulval lesion in an HIV infected woman. Int J STD AIDS2007;18:218–9
17.
FangmanWL, RaoCH, MyersSA. Hypertrophic herpes simplex virus in HIV patients. J Drugs Dermatol2003;2:198–201
18.
GhislanzoniM, CusiniM, ZerboniR, AlessiE. Chronic hypertrophic acyclovir resistant genital herpes treated with topical cidofovir and with topical foscarnet at recurrence in an HIV positive man. J Eur Acad Dermatol Venereol2006;20:887–9
19.
SamaratungaH, WeedonD, MusgraveN, Mc CallumN. Atypical herpetic vulval ulcer in an African woman. An important lesion. Int J STD AIDS2006;17:427–8
20.
TongP, MutasimDF. Herpes simplex virus infection masquerading as condylomata accuminata in a patient with HIV disease. Br J Dermatol1996;134:797–800
21.
SiegalFP, LopezC, HammerGS, Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Eng J Med1981;305:1439–44
22.
StewartJA, ReefSE, PelletPE, CoreyL, WhitleyRJ. Herpesvirus infections in persons infected with human immunodeficiency virus. Clin Infect Dis1995;21(Suppl 1):S114–20
23.
RosenT, BrownTJ. Genital ulcers:evaluation and treatment. Dermatol Clin1998;16:673–85
24.
Al RajabiW, VenturiniM, SalaR, CalzavarapintonP. Wegeners Granulomatosis of the penis: genital peresentation of systemic disease. Dermatology2006;212:370–2
25.
AlpsoyE, ElpekGO, YilmazF, Androgen receptor levels of oral and genital ulcers and skin pathergy test in patients with Bechet disease. Dermatology2005;210:31–5
26.
DehenL, VilmerC. Herpes genital de presentation tumorale chez une patiente infectee par le VIH. Ann Dermatol Venereol2006;133:393–4
27.
StrickLB, WaldA, CelcumC. Management of herpes simplex virus type 2 infection in HIV type 1 infected persons. Clin Infect Dis2006;43:347–56
28.
CouppieP, SarazinF, ClytiE, Increased incidence of genital herpes after HAART initiation: A frequent presentation of immune reconstitution inflammatory syndrome (IRIS) in HIV infected patients. AIDS Patient Care STDs. 2006;20:143–5
29.
FoxPA, BartonSE, FrancisN, Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease. HIV Med1999;1:10–8
