II. History: Prodrome (occurs in 50% of cases, hours to days before lesions)
- Focal genital Paresthesias, dysesthesia, numbness
III. Signs
- Lymphadenopathy: slight, mildly tender
- Vessicles ulcerate and then crust
- Solitary or 3-4
- Enlarges over 3-4 days
- Peaks at 4-8 days
IV. Diagnosis
- See HSV Test
V. Course
- Viral shedding during first 3-4 days
- Recurrence: 5-8 episodes per year
VI. Management: Episodic in Immunocompetent Patients (Start within 24 hours of first symptoms):
-
Acyclovir
- Acyclovir 400 mg orally three times daily for 5 days OR
- Acyclovir 800 mg orally twice daily for 5 days OR
-
Acyclovir 800 mg orally three times daily for 2 days
- Two day regimen as effective as 5 day
- Wald (2002) Clin Infect Dis 34:944-8 [PubMed]
-
Famciclovir
- Famciclovir 125 mg orally twice daily for 5 days OR
- Famciclovir 250 mg orally twice daily for 2 days (500 mg for first dose) OR
- Famciclovir 1000 mg orally twice daily for 1 day
-
Valacyclovir
- Valacyclovir 500 mg orally twice daily for 3 days OR
- Valacyclovir 1000 mg orally once daily for 5 days
VII. Management: Episodic in Immunocompromised Patients (e.g. HIV)
-
Acyclovir
- Acyclovir 400 mg orally three times daily for 5-10 days
-
Famciclovir
- Famciclovir 500 mg orally twice daily for 5-10 days
-
Valacyclovir
- Valacyclovir 1000 mg orally twice daily for 5-10 days
VIII. Management: Suppression/Prophylaxis in Immunocompetent Patients
- Suppression reduces recurrences by ~50%
- Indications for suppression
- More than 6 episodes per year
- Consider for disabling episodes less often
-
Acyclovir
- Acyclovir 400 mg orally twice daily
- Duration
- Typically used for 12 months (Appears safe for up to 6 years)
- Consider as prophylaxis at stress times
- Efficacy
- Decreases episodes from 11.4 to 1.8 per year
- Kaplowitz (1991) JAMA 265:747-51 [PubMed]
-
Famciclovir
- Famciclovir 250 mg orally twice daily
-
Valacyclovir
- Valacyclovir 500 to 1000 mg orally daily
- Efficacy
- Reduces HSV-2 transmission to partner by 50%
- Corey (2004) N Engl J Med 350:11-20 [PubMed]
IX. Management: Suppression/Prophylaxis in Immunocompromised Patients (e.g. HIV)
- Acyclovir 400 to 800 mg orally twice to three times daily OR
- Famciclovir 500 mg orally twice daily OR
- Valaciclovir 500 mg orally twice daily
X. Course
- Recurrence rate: Four episodes per year
- Factors predictive of more frequent recurrences
- Severe primary outbreak
- Male gender
- More frequent initially, decrease over time
- Exposure to provocative factors
- Fever
- Trauma
- Stressful situations
- Heat or cold extreme exposure
- Immunocompromised
- Menses
XI. References
- Beauman (2005) Am Fam Physician 72(8):1527-34 [PubMed]
- Cleach (2014) Cochrane Database Syst Rev (8):CD009036 [PubMed]
- Gnan (2016) N Engl J Med 375(7):666-74 +PMID:27532832 [PubMed]
- Groves (2016) Am Fam Physician 93(11): 928-34 [PubMed]
- Kimberlin (2004) N Engl J Med 350(19): 1970-7 [PubMed]
- Nadelman (2000) Postgrad Med 107(3):189-95 [PubMed]
- Plunkett (2024) Am Fam Physician 110(5): 487-92 [PubMed]
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Related Studies
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Concepts | Disease or Syndrome (T047) |
ICD9 | 054.11 |
SnomedCT | 27420004 |
Dutch | herpesvulvovaginitis |
French | Vulvovaginite herpétique |
German | herpetische Vulvovaginitis |
Italian | Vulvovaginite erpetica |
Portuguese | Vulvovaginite herpética |
Spanish | Vulvovaginitis herpética, vulvovaginitis herpética (trastorno), vulvovaginitis herpética |
Japanese | ヘルペス性外陰腟炎, ヘルペスセイガイインチツエン |
English | herpetic vulvovaginitis, herpetic vulvovaginitis (diagnosis), Herpetic vulvovaginitis, Herpetic vulvovaginitis (disorder), Herpetic Vulvovaginitis |
Czech | Herpetická vulvovaginitida |
Hungarian | Herpetikus vulvovaginitis |
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French | Ulcération herpétique de la vulve |
German | Herpes-Ulzeration der Vulva |
Italian | Ulcerazione erpetica della vulva |
Portuguese | Ulceração herpética da vulva |
Spanish | Ulceración herpética de la vulva, ulceración herpética de la vulva (trastorno), ulceración herpética de la vulva, ulceración vulvar herpética |
Japanese | ガイインブヘルペスカイヨウ, 外陰部ヘルペス潰瘍 |
English | vulvar ulceration herpetic, herpetic ulceration of vulva, herpetic ulceration of vulva (diagnosis), Herpetic ulcer of vulva, Herpes simplex vulvitis, Herpetic ulceration of vulva, Herpetic ulceration of vulva (disorder) |
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Spanish | Infección herpética del pene, infección herpética del pene (trastorno), infección herpética del pene, infección peniana herpética |
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English | herpetic infection of penis (diagnosis), herpetic infection of penis, Herpetic infect of penis, Herpetic infection of penis, Herpetic infection of penis (disorder) |
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