Herpes Simplex and Zoster — Skin MCQ — NEET PG Practice Question | NEETPGAI
Herpes Simplex and Zoster — Skin
medium
hand Dermatology
Regarding herpes simplex virus (HSV) infection of the skin, all of the following statements are correct EXCEPT:
A. Recurrent HSV lesions are preceded by reactivation of latent virus in sensory nerve ganglia and typically appear in the same anatomical location
B. Primary HSV infection is often asymptomatic or causes mild symptoms, whereas recurrent infection typically presents with prodromal symptoms such as burning or tingling
C. HSV-1 is transmitted primarily through respiratory droplets and oral secretions, while HSV-2 is almost exclusively sexually transmitted
D. Tzanck smear shows multinucleated giant cells and is diagnostic of HSV infection with 100% specificity
Explanation
Analysis of HSV Skin Infection Statements
Correct Statements (Options 0, 1, 3)
Option 0 — Primary vs Recurrent HSV
Primary HSV: often asymptomatic or mild; may present with systemic symptoms (fever, malaise, lymphadenopathy)
Recurrent HSV: preceded by prodromal symptoms (burning, tingling, pain) at the site of reactivation
This distinction is clinically important for patient counseling
Option 1 — Transmission Routes
HSV-1: respiratory droplets, oral secretions, saliva → oral herpes most common
HSV-2: sexually transmitted → genital herpes most common
Cross-infection can occur but the stated pattern is the epidemiological norm
Option 3 — Recurrence Pattern
Latency: virus resides in sensory nerve ganglia (trigeminal for orofacial HSV-1; sacral for genital HSV-2)
Reactivation triggered by stress, immunosuppression, fever, UV exposure, menstruation
Lesions typically recur in the same dermatome/anatomical area
Incorrect Statement (Option 2) — The Answer
Key Point
Tzanck smear is a rapid, inexpensive screening tool but is NOT diagnostic with 100% specificity.
Table
Feature
Tzanck Smear
Sensitivity
60–80%
Specificity
50–80%
Finding
Multinucleated giant cells, acantholysis
Limitation
Cannot differentiate HSV from VZV; both show identical cytopathic changes
Gold standard
PCR, viral culture, HSV serology
Warning
Tzanck smear shows the same multinucleated giant cells in both HSV and varicella-zoster virus (VZV) infections — it cannot distinguish between them. Specificity is therefore limited to "herpesvirus infection," not HSV specifically.
Clinical Pearl
Tzanck smear is useful for rapid bedside diagnosis of herpesvirus infection in resource-limited settings, but confirmatory testing (PCR, culture) is needed for HSV-specific diagnosis and antiviral therapy decisions.
High-YieldNEET PG
For NEET PG, remember: Tzanck = fast but not specific; PCR = gold standard for HSV vs VZV differentiation.
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