Primary Herpes Simplex viral infection of bilateral nipples and areolae with reactive arthritis: An uncommon presentation of a common disease

Herpes Simplex Viruses (HSV) are members of the Herpesvirales, subfamily Alphaherpesvirinae. They are linear double standard DNA viruses. Skin manifestations caused by HSV is one of the commonest cutaneous infectious diseases encountered during dermatology practice. It affects most people on one or more occasions during their lives. Cutaneous presentations are characterized by painful localized grouped vesicles. Type 1 HSV is mainly associated with orofacial involvement. Type 2 HSV is mainly associated with anorectal involvement. However, HSV infection can occur almost any area of skin or mucous membrane. Characteristic nature of this virus is its dormant stage after primary infection. After the primary episode of infection, HSV resides in a latentstate in spinal dorsal root ganglia. During a recurrence, the virus follows the nerves that supplies cutaneous sensation onto the skin or mucous membranes, where it multiplies, causing the clinical lesion. After each attack, it enters the resting state. During an attack, the virus can be inoculated into new sites of skin, which can then develop blisters as well as the original site of infection. Primary attacks of Type 1 HSV infections occur mainly in infants and young children. Type 2 HSV infections occur mainly after puberty and are often transmitted sexually. HSV is transmitted by direct or indirect contact with person with active herpes simplex, which is infectious for 7–12 days. Asymptomatic shedding of the virus in saliva or genital secretions can also lead to transmission of HSV, but this is infrequent, as the amount shed from inactive lesions is less than when it is active. The incubation period of the infection is 2–12 days. Minor injury helps inoculate HSV into the skin. For example: A thumb sucker may transmit the virus from their mouth to their thumb, HSV involving nipple is seldom reported in the literature.