Skip to main content

Herpes simplex virus and the alimentary tract

Abstract

Herpes simplex virus (HSV) infection is well known as a sexually transmitted disease. However, relatively little has been published concerning the presentations and treatment of HSV infection within the gastrointestinal tract, where HSV most commonly affects the esophagus in both immunocompromised and immunocompetent patients. HSV proctitis is not uncommon and occurs primarily in males having sex with males. In patients with normal immune systems, gastrointestinal HSV infections are generally self-limited and rarely require antiviral therapy. Treatment of infection is suggested for immunocompromised patients, though no large randomized controlled trials have been performed. This article reviews the manifestations of HSV infection within the luminal gastrointestinal tract and options for diagnosis and treatment.

This is a preview of subscription content, access via your institution.

References and Recommended Reading

  1. Castagliuolo I, Brun P, Constantini M, et al.: Esophageal achalasia: is the herpes simplex virus really innocent? J Gastrointest Surg 2004, 8:24–30.

    Article  PubMed  Google Scholar 

  2. Fatahzadeh M, Schwartz RA: Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007, 57:737–763.

    Article  PubMed  Google Scholar 

  3. Steiner I, Kennedy PG, Pachner AR: The neurotropic herpes virus: herpes simplex and varicella-zoster. Lancet 2007, 6:1015–1028.

    Article  CAS  Google Scholar 

  4. Schacker T, Zeh J, Hu H, et al.: Frequency of symptomatic and asymptomatic herpes simplex virus type 2 reactivation among human immunodeficiency virus-infected men. J Infect Dis 1998, 78:1616–1622.

    Article  Google Scholar 

  5. Drew WL, Buhles W, Erlich KS: Herpesvirus infections (cytomegalovirus, herpes simplex virus, varicella-zoster virus). How to use ganciclovir (DHPG) and acyclovir. Infect Dis Clin North Am 1988, 2:495–509.

    PubMed  CAS  Google Scholar 

  6. Kato S, Yamamoto R, Yoshimitsu S, et al.: Herpes simplex esophagitis in the immunocompetent host. Dis Esophagus 2005, 18:340–344.

    Article  PubMed  CAS  Google Scholar 

  7. Galbraith JC, Shafran SD: Herpes simplex esophagitis in the immunocompetent patient: report of four cases and review. Clin Infect Dis 1992, 14:894–901

    PubMed  CAS  Google Scholar 

  8. Ramanathan J, Rammouni M, Baran J, Khatib R: Herpes simplex virus esophagitis in the immunocompetent host: an overview. Am J Gastroenterol 2000, 95:2171–2176.

    Article  PubMed  CAS  Google Scholar 

  9. Cattan P, Cuillerier E, Cellier C, et al.: Black esophagus associated with herpes esophagitis. Gastrointest Endosc 1999, 49:105–107.

    Article  PubMed  CAS  Google Scholar 

  10. Fishbein PG, Tuthill R, Kressel H, et al.: Herpes simplex esophagitis: a cause of upper-gastrointestinal bleeding. Dig Dis Sci 1979, 24:540–544.

    Article  PubMed  CAS  Google Scholar 

  11. Itoh T, Takahashi T, Kusaka K, et al.: Herpes simplex esophagitis from 1307 autopsy cases. J Gastroenterol Hepatol 2003, 18:1407–1411.

    Article  PubMed  Google Scholar 

  12. Matsumoto J, Sumiyoshi A: Herpes simplex esophagitis—a study in autopsy series. Am J Clin Pathol 1985, 84:96–99.

    PubMed  CAS  Google Scholar 

  13. Wishingrad M: Sexually transmitted esophagitis: primary herpes simplex virus type 2 infection in a healthy man. Gastrointest Endosc 1999, 50:845–846.

    Article  PubMed  CAS  Google Scholar 

  14. Nash G, Ross JS: Herpetic esophagitis: a common cause of esophageal ulceration. Hum Pathol 1974, 5:339–345.

    Article  PubMed  CAS  Google Scholar 

  15. Higuchi D, Sugawa C, Shah SH, et al.: Etiology, treatment, and outcome of esophageal ulcers: a 10-year experience in an urban emergency hospital. J Gastrointest Surg 2003, 7:836–842.

    Article  PubMed  Google Scholar 

  16. Genereau T, Lortholary O, Bouchard O, et al.: Herpes simplex esophagitis in patient with AIDS: report of 34 cases. Clin Infect Dis 1996, 22:926–931.

    PubMed  CAS  Google Scholar 

  17. Wilcox CM, Schwartz DA, Clark WS: Esophageal ulceration in human immunodeficiency virus infection: causes, response to therapy and long term outcome. Ann Intern Med 1995, 123:143–149.

    PubMed  CAS  Google Scholar 

  18. Connolly GM, Hawkins D, Harcourt-Webster JN, et al.: Oesophageal symptoms, their causes, treatment, and prognosis in patients with the acquired immunodeficiency syndrome. Gut 1989, 30:1033–1039.

    Article  PubMed  CAS  Google Scholar 

  19. Bonacini M, Young T, Laine L: The causes of esophageal symptoms in human immunodeficiency virus infection: a prospective study of 110 patients. Arch Intern Med 1991, 151:1567–1572.

    Article  PubMed  CAS  Google Scholar 

  20. Dieckhaus KD, Hill DR: Boerhaave’s syndrome due to herpes simplex virus type 1 esophagitis in a patient with AIDS. Clin Infect Dis 1998, 26:1244–1245.

    PubMed  CAS  Google Scholar 

  21. Cirillo NW, Lyon DT, Schuller AM: Tracheoesophageal fistula complicating herpes esophagitis in AIDS. Am J Gastroenterol 1993, 88:587–589.

    PubMed  CAS  Google Scholar 

  22. Becker K, Lubke HJ, Borchard F, Haussinger D: Inflammatory esophageal diseases caused by herpes simplex virus infections—overview and report of 15 personal cases. Z Gastroenterol 1996, 34:286–295.

    PubMed  CAS  Google Scholar 

  23. Nahass GT, Goldstein BA, Zhu WY, et al.: Comparison of Tzanck smear, viral culture, and DNA diagnostic methods in detection of herpes simplex and varicella-zoster infection. JAMA 1992, 268:2541–2544.

    Article  PubMed  CAS  Google Scholar 

  24. Cronstedt JL, Bouchama A, Hainau B, et al.: Spontaneous esophageal perforation in herpes simplex esophagitis. Am J Gastroenterol 1992, 87:124–127.

    PubMed  CAS  Google Scholar 

  25. Van Ongeval J, Rutgeerts L, Ghillebert G: Herpetic esophagitis in 5 immunocompetent patients. Ned Tijdschr Geneeskd 1996, 140:1367–1371.

    PubMed  Google Scholar 

  26. Jun DW, Kim DH, Kim SH, et al.: Ménétrier’s disease associated with herpes infection: response to treatment with acyclovir. Gastrointest Endosc 2007, 65:1092–1095.

    Article  PubMed  Google Scholar 

  27. Tsamakidis K, Panotopoulou E, Dimitroulopoulos D, et al.: Herpes simplex virus type 1 in peptic ulcer disease: an inverse association with Helicobacter pylori. World J Gastroenterol 2005, 11:6644–6649.

    PubMed  CAS  Google Scholar 

  28. Kang JY, Lee TP, Guan R, et al.: Antibody to herpes simplex virus type 1 in peptic ulcer patients. J Gastroenterol Hepatol 1990, 5:387–390.

    Article  PubMed  CAS  Google Scholar 

  29. Archimandritis A, Markoulatos P, Tjivras M, et al.: Herpes simplex virus types 1 and 2 and cytomegalovirus in peptic ulcer disease and non-ulcer dyspepsia. Hepato-Gastroenterol 1992, 39:540–541.

    CAS  Google Scholar 

  30. Rand KH, Jacobson DG, Cottrell R, et al.: Antibodies to herpes simplex type 1 in patients with active duodenal ulcer. Arch Intern Med 1983, 143:1917–1920.

    Article  PubMed  CAS  Google Scholar 

  31. van der Merve CF, Alexander JJ: Herpes simplex virus and duodenal ulceration [letter]. Lancet 1982, 2(8301):762.

    PubMed  Google Scholar 

  32. Vestergaard BF, Rune SJ: Type-specific herpes-simplex-virus antibodies in patients with recurrent duodenal ulcer. Lancet 1980, 1(8181):1273–1274.

    Article  PubMed  CAS  Google Scholar 

  33. Toljamo KT, Niemelä SE, Karttunen TJ, et al.: The role of Herpes simplex and Helicobacter pylori infection in the etiology of persistent or recurrent gastric erosions: a follow-up study. Dig Dis Sci 2002, 47:818–822.

    Article  PubMed  CAS  Google Scholar 

  34. Lohr JM, Nelson JA, Oldstone MB: Is herpes simplex virus associated with peptic ulcer disease? J Virol 1990, 64:2168–2174.

    PubMed  CAS  Google Scholar 

  35. Kemker BP Jr, Docherty JJ, De Lucia A, et al.: Herpes simplex virus: a possible etiologic agent in some gastroduodenal ulcer disease. Am Surg 1992, 58:775–778.

    PubMed  Google Scholar 

  36. Kingreen D, Nitsche A, Beyer J, Siegert W: Herpes simplex infection of the jejunum occurring in the early post-transplantation period. Bone Marrow Transplant 1997, 20:989–991.

    Article  PubMed  CAS  Google Scholar 

  37. Naik HR, Chandrasekar PH: Herpes simplex virus (HSV) colitis in a bone marrow transplant recipient. Bone Marrow Transplant 1996, 17:285–286.

    PubMed  CAS  Google Scholar 

  38. Delis S, Kato T, Ruiz P, et al.: Herpes simplex colitis in a child with combined liver and small bowel transplant. Pediatr Transplant 2001, 5:374–377.

    Article  PubMed  CAS  Google Scholar 

  39. Adler A, Goldman M, Liesnard C, et al.: Diffuse herpes simplex virus colitis in a kidney transplant recipient successfully treated with acyclovir. Transplantation 1987, 43:919–921.

    Article  PubMed  CAS  Google Scholar 

  40. Hann IM, Prentice HG, Blacklock HA, et al.: Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial. Br Med J (Clin Res Ed) 1983, 287:384–388.

    CAS  Google Scholar 

  41. Hodson EM, Barclay PG, Craig JC, et al.: Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev 2005, CD003774.

  42. Rompalo A: Diagnosis and treatment of sexually acquired proctitis and proctocolitis: an update. Clin Infect Dis 1999, 28(Suppl 1):S84–S90.

    PubMed  Google Scholar 

  43. Quinn TC, Walter ES, Goodell SE, et al.: The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 1983, 309:576–582.

    PubMed  CAS  Google Scholar 

  44. Goodell SE, Quinn TC, Mkrtichian E, et al.: Herpes simplex virus proctitis in homosexual men: clinical sigmoidoscopic and histopathological features. N Engl J Med 1983, 308:868–871.

    PubMed  CAS  Google Scholar 

  45. Colemont LJ, Pen JH, Pelckman PA, et al.: Herpes simplex virus type 1 colitis: an unusual cause of diarrhea. Am J Gastroenterol 1990, 85:1182–1185.

    PubMed  CAS  Google Scholar 

  46. Rompalo AM, Mertz GJ, Davis LG, et al.: Oral acyclovir for treatment of first-episode herpes simplex virus proctitis. JAMA 1988, 259:2879–2881.

    Article  PubMed  CAS  Google Scholar 

  47. Cottone M, Pietrosi G, Martorana G, et al.: Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn’s colitis. Am J Gastroenterol 2001, 96:773–775.

    Article  PubMed  CAS  Google Scholar 

  48. El-Serag HB, Zwas FR, Cirillo NW, Eisen RN: Fulminant herpes colitis in a patient with Crohn’s disease. J Clin Gastroenterol 1996, 22:220–223.

    Article  PubMed  CAS  Google Scholar 

  49. Ruther U, Nunnensiek C, Muller HA, et al.: Herpes simplex-associated exacerbation of Crohn’s disease. Successful treatment with acyclovir. Dtsch Med Wochenschr 1992, 117:46–50.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Walter J. Coyle.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lavery, E.A., Coyle, W.J. Herpes simplex virus and the alimentary tract. Curr Gastroenterol Rep 10, 417–423 (2008). https://doi.org/10.1007/s11894-008-0078-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-008-0078-8

Keywords

  • Herpes Simplex Virus
  • Esophagitis
  • Herpes Simplex Virus Type
  • Acyclovir
  • Achalasia