II. History: Prodrome (occurs in 50% of cases, hours to days before lesions)

  1. Focal genital Paresthesias, dysesthesia, numbness

III. Signs

  1. Lymphadenopathy: slight, mildly tender
  2. Vessicles ulcerate and then crust
    1. Solitary or 3-4
    2. Enlarges over 3-4 days
    3. Peaks at 4-8 days

IV. Diagnosis

  1. See HSV Test

V. Course

  1. Viral shedding during first 3-4 days
  2. Recurrence: 5-8 episodes per year

VI. Management: Episodic in Immunocompetent Patients (Start within 24 hours of first symptoms):

  1. Acyclovir
    1. Acyclovir 400 mg orally three times daily for 5 days OR
    2. Acyclovir 800 mg orally twice daily for 5 days OR
    3. Acyclovir 800 mg orally three times daily for 2 days
      1. Two day regimen as effective as 5 day
      2. Wald (2002) Clin Infect Dis 34:944-8 [PubMed]
  2. Famciclovir
    1. Famciclovir 125 mg orally twice daily for 5 days OR
    2. Famciclovir 250 mg orally twice daily for 2 days (500 mg for first dose) OR
    3. Famciclovir 1000 mg orally twice daily for 1 day
  3. Valacyclovir
    1. Valacyclovir 500 mg orally twice daily for 3 days OR
    2. Valacyclovir 1000 mg orally once daily for 5 days

VII. Management: Episodic in Immunocompromised Patients (e.g. HIV)

  1. Acyclovir
    1. Acyclovir 400 mg orally three times daily for 5-10 days
  2. Famciclovir
    1. Famciclovir 500 mg orally twice daily for 5-10 days
  3. Valacyclovir
    1. Valacyclovir 1000 mg orally twice daily for 5-10 days

VIII. Management: Suppression/Prophylaxis in Immunocompetent Patients

  1. Suppression reduces recurrences by ~50%
  2. Indications for suppression
    1. More than 6 episodes per year
    2. Consider for disabling episodes less often
  3. Acyclovir
    1. Acyclovir 400 mg orally twice daily
    2. Duration
      1. Typically used for 12 months (Appears safe for up to 6 years)
      2. Consider as prophylaxis at stress times
    3. Efficacy
      1. Decreases episodes from 11.4 to 1.8 per year
      2. Kaplowitz (1991) JAMA 265:747-51 [PubMed]
  4. Famciclovir
    1. Famciclovir 250 mg orally twice daily
  5. Valacyclovir
    1. Valacyclovir 500 to 1000 mg orally daily
    2. Efficacy
      1. Reduces HSV-2 transmission to partner by 50%
      2. Corey (2004) N Engl J Med 350:11-20 [PubMed]

IX. Management: Suppression/Prophylaxis in Immunocompromised Patients (e.g. HIV)

  1. Acyclovir 400 to 800 mg orally twice to three times daily OR
  2. Famciclovir 500 mg orally twice daily OR
  3. Valaciclovir 500 mg orally twice daily

X. Course

  1. Recurrence rate: Four episodes per year
  2. Factors predictive of more frequent recurrences
    1. Severe primary outbreak
    2. Male gender
    3. More frequent initially, decrease over time
    4. Exposure to provocative factors
      1. Fever
      2. Trauma
      3. Stressful situations
      4. Heat or cold extreme exposure
      5. Immunocompromised
      6. Menses

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Herpetic vulvovaginitis (C0019386)

Definition (NCI) Infection of the vulva and the vagina caused by herpes simplex virus.
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

Ontology: Herpetic ulceration of vulva (C0153033)

Concepts Disease or Syndrome (T047)
ICD9 054.12
SnomedCT 59819007
Dutch herpesulceratie van de vulva
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)
Czech Herpetické ulcerace vulvy
Hungarian Vulva herpetikus ulceratiója

Ontology: Herpetic infection of penis (C0153034)

Concepts Disease or Syndrome (T047)
ICD9 054.13
SnomedCT 10227000
Dutch herpesinfectie van de penis
French Infection herpétique du pénis
German Herpes-Infektion des Penis
Italian Infezione erpetica del pene
Portuguese Infecção herpética do pénis
Spanish Infección herpética del pene, infección herpética del pene (trastorno), infección herpética del pene, infección peniana herpética
Japanese 陰茎ヘルペス感染, インケイヘルペスカンセン
English herpetic infection of penis (diagnosis), herpetic infection of penis, Herpetic infect of penis, Herpetic infection of penis, Herpetic infection of penis (disorder)
Czech Herpetická infekce penisu
Hungarian Penis herpetikus fertőzése

Ontology: Herpetic cervicitis (C1268604)

Concepts Disease or Syndrome (T047)
SnomedCT 129670002
English Herpetic cervicitis (disorder), Herpetic cervicitis
Spanish cervicitis herpética (trastorno), cervicitis herpética

Ontology: Recurrent genital herpes simplex (C1274323)

Concepts Disease or Syndrome (T047)
SnomedCT 402894005
English genital herpes recurrent, recurrent genital herpes, Recurrent genital herpes simplex (diagnosis), herpes simplex genitalis recurrent, Recurrent genital herpes simplex (disorder), Recurrent genital herpes simplex, Recurrent herpes genitalis
Spanish herpes simplex genital recurrente (trastorno), herpes simplex genital recurrente