What can mask the presence of neonatal herpes, making diagnosis challenging?

The absence of rash can mask the presence of neonatal herpes, thereby complicating the diagnosis. Newborns with herpes simplex virus (HSV) infections may not always present with visible lesions or rashes, particularly in early stages of the disease. In fact, some infants may not exhibit any skin findings at all, which can lead to a misdiagnosis or delayed recognition of the infection.

Despite the classic signs often associated with herpes, such as lesions that might be expected, a neonate could still be infected without developing these visible symptoms. Health care providers must be aware that the clinical presentation of neonatal herpes can be subtle and not necessarily associated with a rash, emphasizing the importance of further investigation and consideration of the infant’s overall clinical picture.

In contrast, the other options—presence of fever, persistent vomiting, and severe lethargy—are symptoms that can indicate illness and may prompt further evaluation, including for infections such as herpes. However, they are not specific indicators of herpes and may arise from numerous other conditions, making them less effective at masking the infection itself compared to the absence of a rash.