Primary Genital Herpes

Aka: Primary Genital Herpes, Acute Genital Herpes, Initial Genital Herpes

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II. Symptoms: Prodrome (precedes genital lesions by hours to days)

  1. Genital symptoms
    1. Focal, genital pain, Paresthesias, burning, itching
    2. Lesions occur at the perineum, buttock, upper thigh or perianal area
  2. Systemic symptoms
    1. Fever
    2. Headache
    3. Malaise
    4. Myalgias

III. Signs: Skin Lesions

  1. Lesion development
    1. Starts as shallow Vesicle
    2. Umbilicates with central depression
    3. Ulcerate early in course
    4. Crusts and then re-epitheliazes without scarring
  2. Multiple, grouped lesions are common and may coalesce
  3. Very painful on ulceration
  4. Present for 4-15 days

IV. Signs: Adenopathy

  1. Starts during second or third week of disease
  2. Usually bilateral inguinal adenopathy
  3. Slightly enlarged, mildly tender

V. Course

  1. Viral shedding: 15-16 days
  2. Complete lesion healing: 19-21 days

VI. Diagnosis

  1. See HSV Test

VII. Management

  1. See Genital Herpes in Pregnancy
  2. See Genital Herpes
  3. Outpatient
    1. General
      1. Shortens duration of pain and period of viral shedding
      2. May extend Antiviral course beyond 10 days if incomplete healing
    2. Acyclovir
      1. Acyclovir 400 mg orally three times daily for 7-10 days OR
      2. Acyclovir 200 mg orally five times daily for 7-10 days
    3. Famciclovir 250 mg orally three times daily for 7-10 days
    4. Valacyclovir 1000 mg orally twice daily for 7-10 days
  4. Inpatient
    1. Indications: Severe or complicated Herpes Simplex Virus Infection
      1. HSV-related hepatitis
      2. HSV Encephalitis
      3. HSV pneumonitis
    2. First-Line
      1. Acyclovir 5-10 mg/kg IV every 8h for 5 to 7 days
      2. Convert to oral agents when able
    3. Second-Line: Acyclovir resistant cases
      1. Foscarnet 80-120 mg/kg/day divided 2-3 times daily for 7 days OR
      2. Cidofovir 5 mg/kg IV every week until clinical response

VIII. Complications

  1. See Genital Herpes

IX. References

  1. Beauman (2005) Am Fam Physician 72(8):1527-34 [PubMed]
  2. Groves (2016) Am Fam Physician 93(11): 928-34 [PubMed]
  3. Kimberlin (2004) N Engl J Med 350(19): 1970-7 [PubMed]
  4. Nadelman (2000) Postgrad Med 107(3):189-95 [PubMed]
  5. Plunkett (2024) Am Fam Physician 110(5): 487-92 [PubMed]

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