Clinical presentation

A. Primary genital episode genital HSV is characterized by multiple painful vesicles in clusters. They may be associated with pruritus, dysuria, vaginal discharge, and tender regional adenopathy. Fever, malaise, and myalgia often occur one to two days prior to the appearance of lesions. The lesions may last four to five days prior to crusting. The skin will reepithelialize in about 10 days. Viral shedding may last for 10 to 12 days after reepithelialization.

B. Nonprimary first-episode genital HSV refers to patients with preexisting antibodies to one of the two types of virus who acquire the other virus and develop genital lesions. Nonprimary disease is less severe with fewer systemic symptoms, and less local pain.

C. Recurrent HSV episodes are characterized by local pain or paresthesia followed by vesicular lesions. Lesions are generally fewer in number and often unilateral but may be painful.

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