A 2-year-old girl presented with an outbreak of herpes simplex virus (HSV)-1. How can I determine if this is a result of abuse or exposure from a vaginal birth of an HSV-positive mother?—CONNIE KELLY, FNP, Franklin, N.Y.

It’s hard to answer this question without knowing whether the outbreak occurred in the genital area or on the face. While generally associated with the trigeminal nerve, HSV-1 may inhabit the sacral nerves as well. If this is a serologically confirmed genital HSV-1 outbreak, the cause is most likely contact with an oral lesion that occurred after birth (exposure during birth is a very rare occurrence). If the outbreak is elsewhere, it is most likely not associated with abuse (MMWR Recomm Rep. 2010;59(RR-12):1-110; available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm, accessed February 15, 2011). Get a local child-abuse expert involved if you are at all concerned. New York residents should contact the Sexual Abuse Medical Provider Program (www.champprogram.com).—Julee B. Waldrop, DNP (149-3)