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Primary Genital Herpes
Aka: Primary Genital Herpes, Acute Genital Herpes, Initial Genital Herpes
- See Also
- Genital Herpes in Pregnancy
- Genital Herpes
- Secondary Genital Herpes
- Genital Ulcer
- Sexually Transmitted Disease
- Symptoms: Prodrome (precedes genital lesions by hours to days)
- Genital symptoms
- Focal, genital pain, Paresthesias, burning, itching
- Lesions occur at the perineum, buttock, upper thigh or perianal area
- Systemic symptoms
- Fever
- Headache
- Malaise
- Myalgias
- Signs: Skin Lesions
- Lesion development
- Starts as shallow Vesicle
- Umbilicates with central depression
- Ulcerate early in course
- Crusts and then re-epitheliazes without scarring
- Multiple, grouped lesions are common and may coalesce
- Very painful on ulceration
- Present for 4-15 days
- Signs: Adenopathy
- Starts during second or third week of disease
- Usually bilateral inguinal adenopathy
- Slightly enlarged, mildly tender
- Course
- Viral shedding: 15-16 days
- Complete lesion healing: 19-21 days
- Diagnosis
- See HSV Test
- Management
- See Genital Herpes in Pregnancy
- See Genital Herpes
- Outpatient
- General
- Shortens duration of pain and period of viral shedding
- Acyclovir
- Acyclovir 400 mg orally three times daily for 7-10 days OR
- Acyclovir 200 mg orally five times daily for 7-10 days
- Famciclovir 250 mg orally three times daily for 7-10 days
- Valacyclovir 1000 mg orally twice daily for 7-10 days
- Inpatient
- Indications: Severe or complicated Herpes Simplex Virus Infection
- HSV-related hepatitis
- HSV Encephalitis
- HSV pneumonitis
- Protocol
- Acyclovir 5-10 mg/kg IV q8h for 2 to 7 days
- Convert to oral agents when able
- Complications
- See Genital Herpes
- References
- Beauman (2005) Am Fam Physician 72(8):1527-34 [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]