Introduction
Skin and soft tissue infections remain a common 
concern in athletes, particularly in sports with 
frequent close contact such as wrestling and football. 
While the overall incidence across all athletes is 
relatively modest, these conditions account for a 
measurable proportion of sports-related adverse 
events, with estimates of approximately 8.5% in 
some high-risk sports, underscoring their clinical and 
operational significance. Outbreaks can rapidly 
disrupt training and competition because of the ease 
of transmission, mandatory exclusion periods, and 
the potential for secondary complications. Early 
identification, appropriate treatment, and adherence 
to established hygiene and return-to-play protocols 
are therefore essential to limiting morbidity and 
maintaining team availability. Herpes virus is a 
highly contagious disease and will be discussed in 
this article.
Herpes Virus
Herpes Gladiatorum (HG) is a highly contagious 
cutaneous infection caused by herpes simplex virus 
type 1 and type 2, most frequently affecting athletes 
in contact sports such as wrestling. Transmission 
occurs primarily via direct skin-to-skin contact often 
involving the head, neck, and face with an incubation 
period averaging 8 days (range: up to 2 weeks). 
Outbreaks are common in team environments, with 
prevalence rates in wrestling teams reported as high 
as 29%. Early recognition is important to reduce the 
risk of spread.
Clinical Presentation and Recognition
Primary herpes often has systemic involvement and 
diffuse patches of grouped 2-mm vesicles on an 
erythematous base, typically on the head, neck, or 
upper extremities. Lesions typically last 10-14 days. 
Lesions may recur due to UV light exposure, cutting 
weight, poor nutrition, reexposure, autoinoculation, 
reactivation triggered by fatigue, stress, rubbing of 
the area, or coexisting infection. Complications, 
though rare, can be severe especially when they 
involve the eyes (acute retinal necrosis) which can 
lead to blindness. Recurrent outbreaks often produce 
fewer vesicles and the outbreaks are smaller and 
shorter in duration. 
Treatment Protocols 
Treatment does not eradicate the virus from the 
nerve ganglion, but can help to expedite infection 
clearance. Oral antiviral therapy (e.g., acyclovir or 
valacyclovir) initiated within 48 hours of lesion 
onset can lessen the duration and severity of the 
infection. For primary HG, athletes with skin-to-skin 
exposure should be treated and withheld from com-
petition for a minimum of 10 days. For recurrent 
HG, athletes should be withheld for a minimum of 5 
days. Prophylactic valacyclovir (1 g daily) during 
A Clinical Review of Herpes Gladiatorum
Authors: Timothy Huang, MD and Gianpaolo Rufo, DO
5

View this content as a flipbook by clicking here.