From the Guidelines
Herpes simplex virus (HSV) in males typically presents as painful blisters or sores on the penis, scrotum, thighs, buttocks, or around the anus, with symptoms often including flu-like symptoms, tingling, itching, or burning sensations before the appearance of sores. These lesions begin as small red bumps that develop into fluid-filled blisters, which eventually break open, leaving painful ulcers that may take 2-4 weeks to heal. Men may also experience fever, headache, muscle aches, and swollen lymph nodes in the groin during the initial outbreak. Some men report a tingling, itching, or burning sensation before the appearance of sores.
Symptoms and Treatment
- The symptoms of HSV in males can be managed with antiviral medications such as acyclovir, valacyclovir, or famciclovir, as discussed in the 2022 study 1.
- Treatment typically involves antiviral medications for initial outbreaks, with options including acyclovir (400mg three times daily for 7-10 days), valacyclovir (1g twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days).
- For recurrent episodes, the same medications may be used at similar or reduced dosages for a shorter duration of 3-5 days, as noted in the study 1.
- Daily suppressive therapy with these antivirals can reduce outbreak frequency for men with frequent recurrences, as mentioned in the study 1.
Prevention and Transmission
- It's essential to avoid sexual contact during outbreaks and to use condoms consistently to reduce the risk of transmission, although transmission can still occur even without visible symptoms due to asymptomatic viral shedding, as discussed in the study 1.
- The use of suppressive therapy can help prevent transmission to sexual partners, as noted in the study 1, but it is not effective in decreasing the risk of transmission among persons with HIV/HSV-2 coinfection.
Diagnosis and Management
- Accurate diagnosis of HSV is crucial, and type-specific assays for HSV, such as viral culture or HSV type-specific serologic tests, can help confirm the infection, as mentioned in the study 1.
- Optimal management of genital herpes includes antiviral therapy and appropriate counseling on the natural history of infection, risk for sexual and perinatal transmission, and methods to prevent further transmission, as discussed in the study 1.
From the Research
Symptoms of Herpes Simplex (HSV) in Males
The symptoms of Herpes Simplex (HSV) in males can be characterized by:
- A severe first attack followed by mild recurrences, which are more common and frequent after HSV-2 than after HSV-1 genital infection 2
- Clinical features including prodrome, vesicles, and erosions, which may be characteristic and allow for rapid clinical diagnosis 2
- Vesicular and erosive localized painful genital lesions, typically on the prepuce, glans penis, and penile shaft 3
Treatment and Management
Treatment and management of HSV in males may involve:
- Oral acyclovir, which is the drug of choice for initial attacks and can be used to treat mild disease affecting only the skin 2
- Topical treatment with 5% acyclovir cream for mild disease affecting only the skin 2
- Ultrasound and Herpigon treatment, which has been shown to reduce the recurrent infection in some cases 3
- Valacyclovir, which is a highly bioavailable prodrug of acyclovir and can be used to treat herpes simplex, herpes zoster, and other viral infections 4
- Suppressive antiviral therapy with acyclovir, valacyclovir, or famciclovir, which can decrease the number of patients with at least one recurrence per year 5
Complications and Considerations
Complications and considerations for HSV in males may include:
- Systemic complications, such as primary herpes in late pregnancy, which can be an important but rare problem 2
- Psychosocial distress, which can result from the periodic reactivation of the virus and significant symptoms 6
- The need for laboratory confirmation, which should be attempted when possible to ensure accurate diagnosis and treatment 2