Atypical presentation of herpes simplex virus 2 primary infection: a case report.
Antiviral
Case report
Cervicitis
Genital lesions
Herpes simplex virus
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
25 Aug 2024
25 Aug 2024
Historique:
received:
21
05
2024
accepted:
20
07
2024
medline:
26
8
2024
pubmed:
26
8
2024
entrez:
24
8
2024
Statut:
epublish
Résumé
Cervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions. A 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms. Herpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Cervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions.
CASE PRESENTATION
METHODS
A 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms.
CONCLUSION
CONCLUSIONS
Herpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.
Identifiants
pubmed: 39182131
doi: 10.1186/s13256-024-04721-x
pii: 10.1186/s13256-024-04721-x
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
393Informations de copyright
© 2024. The Author(s).
Références
Iqbal U, Wills C. Cervicitis. Treasure Island (FL); 2024 Apr. StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK562193/
Guides sur les Syndromes associés aux ITS : Cervicite. Agence de la santé publique du Canada; 2021 [cited 2024 Apr 24]. https://www.canada.ca/fr/sante-publique/services/maladies-infectieuses/sante-sexuelle-infections-transmissibles-sexuellement/lignes-directrices-canadiennes/syndromes-associes-its/cervicite.html
Alareeki A, Osman A, Khandakji M, Looker K, Harfouche M, Abu-Raddad L. Epidemiology of herpes simplex virus type 2 in Europe: systematic review, meta-analyses, and meta-regressions. Lancet Reg Health Eur. 2023;25:100558.
doi: 10.1016/j.lanepe.2022.100558
pubmed: 36818238
WHO Guidelines for the treatment of Genital Herpes Simplex Virus. 2016 [cited 2024 Apr 6]. https://www.ncbi.nlm.nih.gov/books/NBK396232/pdf/Bookshelf_NBK396232.pdf
Marrazzo J, Martin D. Management of women with cervicitis. Clin Infect Dis. 2007;1(44):S102–10.
doi: 10.1086/511423
Workowski K, Bachmann L, Chan P, Johnston C, Muzny C, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR. 2021;70(4):1.
pubmed: 34292926
pmcid: 8344968
Corey L, Adams H, Brown Z, Holmes K. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983;98(6):958–72.
doi: 10.7326/0003-4819-98-6-958
pubmed: 6344712
Clure C, Rivard C. Primary herpes simplex virus infection mimicking a cervical malignancy in an immunocompetent individual. Cureus. 2018. https://doi.org/10.7759/cureus.2753 .
doi: 10.7759/cureus.2753
pubmed: 30094110
pmcid: 6080739
Tomkins A, White C, Higgins SP. Primary herpes simplex virus infection mimicking cervical cancer. BMJ Case Rep. 2015. https://doi.org/10.1136/bcr-2015-210194 .
doi: 10.1136/bcr-2015-210194
pubmed: 26038382
pmcid: 4460355
Boldrini P, Vallejos G, Ballesteros P, Valenzuela G, Roncone E. Tumor-like presentation of herpetic cervicitis: a case report. Case Rep Womens Health. 2023;5:38.
Funakoshi M, Nakai G, Yamada T, Ohmichi M, Yamamoto K, Osuga K. Acute cervicitis resembling gastric-type mucinous adenocarcinoma that was definitively diagnosed by cervical conization: a case report. Radiol Case Rep. 2023;18(5):1767–71.
doi: 10.1016/j.radcr.2023.02.016
pubmed: 36923387
pmcid: 10009334
Benedetti J, Corey L, Ashley R. Recurrence rates in genital herpes after symptomatic first-episode infection. Ann Intern Med. 1994;121(11):847–54.
doi: 10.7326/0003-4819-121-11-199412010-00004
pubmed: 7978697
Benedetti J, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med. 1999;131(1):14–20.
doi: 10.7326/0003-4819-131-1-199907060-00004
pubmed: 10391810
World Health Organization . 2020. Massive proportion of world’s population are living with herpes infection. https://www.who.int/news/item/01-05-2020-massive-proportion-world-population-living-with-herpes-infection
Patel R, Kennedy OJ, Clarke E, Geretti A, Nilsen A, Lautenschlager S, et al. 2017 European guidelines for the management of genital herpes. Int J STD AIDS. 2017;28(14):1366–79.
doi: 10.1177/0956462417727194
pubmed: 28836892