Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents Disease Specific Recommendations Herpes Simplex Virus Disease Epidemiology Infections with human herpes simplex virus type 1 (HSV1) and type 2 (HSV-2) are common, with a seroprevalence among adults of HSV-1 approaching 80% and of HSV-2 among persons aged >12 years in the United States of 21.9% . Approximately 95% of HIV-1--infected persons are seropositive for either HSV-1 or HSV-2 (432--434). The availability of potent ART has not had an impact on these data.   Clinical Manifestations HSV orolabialis is the most common manifestation of HSV1 infection, presenting with a sensory prodrome in the affected area, rapidly followed by the evolution of lesions from papule to vesicle, ulcer, and crust stages on the lips. Ulcerative lesions are usually the only stage observed on mucosal surfaces. The course of illness in untreated subjects is 7--10 days. Lesions recur 1--12 times per year and are often triggered by sunlight or stress. HSV genitalis is the more common manifestation of HSV2 infection. Perineal lesions on keratinylated skin are similar in appearance and evolution to external orofacial lesions. Local symptoms include a sensory prodrome consisting of pain and pruritis. Ulcerative lesions are usually the only stage observed on vaginal or urethral mucosal surfaces. Mucosal disease is generally accompanied by dysuria, vaginal, or uretheral discharge; inguinal lymphadenopathy, particularly in primary infection, is common with perineal disease . In profoundly immunocompromised patients, extensive, deep, nonhealing ulceration of the perineum/buttocks might occur. These lesions have been most often reported in those with CD4+ T lymphocyte counts of <100 cells/µL and also might be more commonly associated with acyclovir-resistant virus. HSV keratitis, neonatal HSV, HSV encephalitis, and herpetic whitlow are similar in presentation and treatment to those diseases observed in HIV-seronegative persons but might be more severe. HSV retinitis occurs as acute retinal necrosis, occasionally in the setting of HSV encephalitis. HSV encephalitis occurs among HIV-1--infected persons, but no evidence indicates that it is more severe or common than among HIV-uninfected persons.   Diagnosis HSV infections are usually diagnosed empirically on the basis of characteristic skin, mucus membrane, or ophthalmic lesions. With unusual presentations or lesions that do not respond to therapy, swabs from a fresh lesion can be submitted to the diagnostic virology laboratory for Tzanck smear, viral culture, or HSV antigen detection and subsequent antiviral susceptibility testing if necessary.