Fast Five Quiz: Herpes Simplex Virus

Michael Stuart Bronze, MD

Disclosures

September 06, 2022

Primary genital herpes can be caused by both HSV-1 and HSV-2 and can be asymptomatic. HSV-2 tends to have tropism for genital mucosa and has been traditionally more associated with genital infections. Primary genital herpes is characterized by severe and prolonged systemic and local symptoms. Preexisting antibodies to HSV-1 have an ameliorating effect on disease severity caused by HSV-2. Prior orolabial HSV-1 infection appears to protect against or may lower genital HSV-1 infection risk. Symptoms of primary genital herpes are more severe in women, as are complications.

The incubation period of primary genital herpes is typically 3-7 days (range, 1 day to 3 weeks). Constitutional symptoms include fever, headache, malaise, and myalgia (prominent in the first 3-4 days). Local symptoms include pain, itching, dysuria, vaginal and urethral discharge, and tender lymphadenopathy.

In women, herpetic vesicles appear on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus. In moist areas, the vesicles rupture, leaving exquisitely tender ulcers. Ulcers are seen more commonly than vesicles at the time of presentation because of the frailty and thin walls of the vesicles. The vaginal mucosa is inflamed and edematous. The cervix is involved in 70%-90% of cases and is characterized by ulcerative or necrotic cervical mucosa. Cervicitis is the sole manifestation in some patients. Dysuria may be very severe and may cause urinary retention. Dysuria is associated with urethritis, and HSV can be isolated in the urine. HSV-1 infection causes urethritis more often than does HSV-2 infection.

In men, herpetic vesicles appear in the glans penis, the prepuce, the shaft of the penis, and sometimes on the scrotum, thighs, and buttocks. In dry areas, the lesions progress to pustules and then encrust. Herpetic urethritis occurs in 30%-40% of affected men and is characterized by severe dysuria and mucoid discharge. The perianal area and rectum may be involved in persons who engage in anal intercourse, resulting in herpetic proctitis.

In men and women, the ulcerative lesions persist from 4-15 days until encrusting and reepithelialization occur. The median duration of viral shedding is about 12 days.

Learn more about clinical presentation of HSV.

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