Eglantine Lebas

Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections

Chronic herpes simplex virus (CHSV) and chronic varicella zoster virus (CVZV) are defined as atypical mucocutaneous wart-like and/or ulcerative HSV or VZV infections, persisting for at least 1 month. Both are commonly associated with HIV infection and may occasionally present with other types of immunosuppression. CHSV and CVZV occur despite the immune restoration effect of highly active antiretroviral therapy for HIV. The clinical polymorphism of CHSV and CVZV makes recognition difficult. Histology, immunohistology, PCR and viral culture all help to confirm the diagnosis. Treatment is frequently complicated by resistance to thymidine kinase (TK)-dependent antivirals, including acyclovir, valacyclovir and famciclovir. Viral culture remains an essential tool for antiviral drug susceptibility testing. Therapeutic alternatives include non-TK-dependent antivirals, such as foscarnet or cidofovir, which directly target viral DNA polymerase. With few exceptions, CHSV and CVZV infections do not constitute significant risk factors for disseminated cutaneous or systemic infection. This review compares the similarities of and differences between CHSV and CVZV infections.

Viral infections of the pubis

There are no demographic data published on those with viral infections of the pubis (VIPs). We conducted a two-year prospective study to collect demographic information on patients with VIPs. Data were gathered on age, sex, diagnosis, low (≤10) or high (>10) lesion number, symptoms, how the patient discovered the lesions, localization, lesions beyond the pubis, risk factors, shaving habits, human papillomavirus (HPV) vaccination status and treatment. In a total of 61 patients, molluscum contagiosum (MC) was identified in 71%, condylomata acuminata (CA) in 11%, concomitant MC and CA infections in 11% and herpes simplex virus (HSV) infection in 4.8%. Shaving represented a risk factor for a high lesion number, but not for the extension beyond the pubis. MC, CA and HSV infections affecting the pubis are uncommon and often asymptomatic. As they may represent a hidden source of infection we recommend thorough inspection of the pubis during routine skin examination.