From the Guidelines
Herpes meningitis symptoms typically include severe headache, fever, neck stiffness, sensitivity to light (photophobia), and meningismus, accompanied by cerebrospinal fluid (CSF) lymphocytic pleocytosis, as characterized in the 2022 Clinical Infectious Diseases study 1. The symptoms of herpes meningitis can vary, but common presentations include:
- Severe headache
- Fever
- Neck stiffness
- Photophobia
- Meningismus
- CSF lymphocytic pleocytosis
- Mildly elevated protein and normal glucose in CSF, as noted in the study 1 These symptoms usually develop rapidly over hours to days and can be accompanied by other systemic symptoms such as fatigue, muscle aches, and general malaise. It is essential to distinguish cases of HSV encephalitis from HSV meningitis, as HSV encephalitis is a much more severe infection with high neurologic morbidity and mortality, and should be treated with 14–21 days of IV acyclovir 1. The virus reaches the meninges either through primary infection or reactivation of latent virus, causing inflammation that leads to these symptoms. If you experience these symptoms, especially severe headache with fever and neck stiffness, seek immediate medical attention as meningitis requires prompt diagnosis and treatment, typically with antiviral medications like acyclovir, as suggested in the 2022 study 1.
From the Research
Symptoms of Herpes Meningitis
The symptoms of herpes meningitis are not explicitly stated in the provided studies. However, the studies discuss the treatment and management of herpes simplex virus type 2 (HSV-2) meningitis and other herpes-related infections.
Treatment and Management
- The study 2 found that suppressive treatment with valacyclovir did not prohibit recurrent meningitis and cannot be recommended for this purpose after HSV meningitis in general.
- The study 3 describes the pharmacology, pharmacokinetics, and clinical efficacy of valacyclovir for the treatment of herpes simplex, herpes zoster, and other viral infections.
- The study 4 compared the safety and efficacy of famciclovir and acyclovir in patients with herpes zoster and found that both interventions obtained high rates of cure and had a similar time to full crusting of lesions.
Neurological Complications
- The study 2 found that a considerable morbidity rate, comprising symptoms from the central, peripheral, and autonomous nervous system, was found in both groups of patients with HSV-2 meningitis.
- The study 5 discusses the discovery of acyclovir and penciclovir and the development of a successful systemic therapy for treating herpes simplex virus infection and varicella-zoster virus infection.
Antiviral Drugs
- The study 6 discusses the pharmacology of new antiherpes agents, including famciclovir and valacyclovir.
- The study 5 discusses the helicase-primase inhibitors (HPIs) pritelivir and amenamevir, which have novel mechanisms of action, drug resistance properties, pharmacokinetic characteristics, and clinical efficacy for treating genital herpes.