From the Guidelines
Genital herpes caused by HSV-2 typically presents with painful vesicular lesions on the genitalia that progress to ulcers before healing, with initial outbreaks usually being more severe and lasting 2-4 weeks, and may include systemic symptoms like fever, headache, malaise, and myalgia, as reported in the most recent study by 1. The clinical presentation of HSV-2 genital herpes can vary, but common symptoms include:
- Painful vesicular lesions on the genitalia that progress to ulcers before healing
- Prodromal symptoms such as tingling, burning, or itching before visible lesions appear
- Regional lymphadenopathy
- Systemic symptoms like fever, headache, malaise, and myalgia during initial outbreaks After the primary infection, HSV-2 establishes latency in sacral ganglia, leading to recurrent episodes that are generally milder and shorter (5-10 days) than the initial outbreak, as noted in the study by 1. Some infected individuals remain asymptomatic but can still transmit the virus through viral shedding, highlighting the importance of accurate diagnosis and management, as discussed in the study by 1. Diagnosis is typically clinical but can be confirmed with viral culture, PCR, or serologic testing, and treatment includes antiviral medications such as acyclovir, valacyclovir, or famciclovir, with suppressive therapy recommended for patients with frequent recurrences, as outlined in the study by 1. Patients should be counseled about transmission risk, including asymptomatic viral shedding, and the importance of barrier protection during sexual activity, as emphasized in the study by 1.
From the Research
Clinical Presentation of Herpes Simplex Virus (HSV) Type 2 Genital Herpes
The clinical presentation of HSV-2 genital herpes is characterized by:
- A visible outbreak consisting of single or clustered vesicles on the genitalia, perineum, buttocks, upper thighs, or perianal areas that ulcerate before resolving 2
- Symptoms of primary infection may include malaise, fever, or localized adenopathy 2, 3
- Subsequent outbreaks, caused by reactivation of latent virus, are usually milder 2, 3
- Asymptomatic shedding of transmissible virus is common 2
Severity and Duration of Symptoms
- The primary episode of genital herpes is generally the most painful 3
- The clinical features of first episode genital herpes show marked individual variation in severity; they tend to be more severe in women than in men 4
- Local and distant complications are common in immunocompetent individuals and may be life-threatening in those who are immunocompromised 4
Diagnosis and Treatment
- Diagnosis is made clinically, but should be confirmed by culture or serology 3
- Treatment includes antiviral drug therapy, such as acyclovir, valacyclovir, or famciclovir, as well as analgesics 3, 5
- Antiviral treatment decreases the severity and duration of primary genital herpes and of recurrences, and it may be used as a continuous suppressive therapy to decrease the incidence of recurrence 2, 3, 5