Herpetic pharyngitis with mammary and genital herpes due to sexual contact.

A 48-year-old Japanese womanwith no history of herpes simplex visited our hospital in April 1997. Nine days before presentation, she had had sexual contact with a man other than her husband. She did not notice whether he had any herpetic lesions. Four days later, she felt chills, and on the ¢fth day, pain in the right inguinal area. She noticed the development of mucocutaneous lesions on the right nipple and external genitalia on the seventh day. Physical examination showed that she had crusts and erosions on the right nipple and erosions on the right labium minus pudendae. In addition, the right inguinal lymph nodes were swollen. No pharyngeal signs, symptoms, nor any swelling of the cervical lymph nodes was noticed. The patient was administered oral acyclovir 1000 mg/day for 7 days and cefpodoxime proxetil 300 mg/ day for 3 days. On the sixth day of treatment, the lesions on the nipple and genitalia had almost disappeared.We attempted to isolate the virus by using the Vero cell tissue culture system. HSV was isolated in the samples taken from the nipple and genitalia, but not in a pharyngeal swab specimen. Both isolates were identi¢ed as HSV-1 by a direct immuno£uorescence technique using anti-HSV-1 and 2 monoclonal antibodies (Syva MicroTrak1, Genetic Systems Co., Seattle, WA, USA) (2). A polymerase chain reaction (PCR) was then performed in order to detect HSV DNA in the same pharyngeal specimen. The specimen was treated with Gene Release1 (BioVenture, USA), which was used as a template. The primer sequences are located in the regions of the HSV-1 and HSV-2 DNA polymerase genes (3). After 30 PCR cycles consisting of 1min at 943C, 2 min at 553C and 3min at 723C, HSVDNA was detected in the pharyngeal swab specimen. Both serum HSV-speci¢c IgG and IgM antibody titres on the fourth day after onset were less than 1 : 10, respectively, by the indirect immuno£uorescence technique. SerumHSVantibodywas not tested for in the extramarital sexual partner or the patient's husband because they did not visit our hospital.