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Aseptic meningitis has been reported with herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6.
Aseptic meningitis is more common with HSV-2 (HSV-1 is typically associated with encephalitis) and accounts for approximately 1% to 3% of all cases of aseptic meningitis. In one series, 36% of women and 13% of men with primary genital HSV-2 reported a headache, stiff neck, and photophobia. Meningeal symptoms usually start 3 to 12 days after the onset of genital lesions and are usually self-limited in immunocompetent persons.
Cerebrospinal fluid leukocyte counts range from 10 to 1000 cells/mm3 and are predominantly lymphocytic. The CSF protein level is usually elevated, and the CSF glucose level is typically normal, although hypoglycorrhachia has been reported. HSV-2 meningitis can be diagnosed by viral culture, but PCR assay is more sensitive.
Intravenous acyclovir is recommended for the treatment of HSV meningitis. Isolation of herpesviruses with resistance to acyclovir has occurred, and alternative therapies include vidarabine and foscarnet.

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