From the Guidelines
Yes, HSV type 1 can cause rash or visible skin lesions on the foreskin or penis. According to the most recent and highest quality study, genital herpes, caused by herpes simplex virus (HSV) type 1 or type 2, is a prevalent sexually transmitted infection (STI) that can present as recurrent, self-limited genital ulcers 1. While HSV-1 is associated with both oral and genital infection, it can also infect the genital region through oral-genital contact, causing painful blisters or ulcers that may appear on the penis, foreskin, or surrounding areas.
Key Points to Consider
- The lesions often begin as small red bumps that develop into fluid-filled blisters, which then break open, forming painful ulcers that eventually crust over and heal within 2-4 weeks.
- For treatment, antiviral medications like acyclovir, valacyclovir, or famciclovir can help reduce symptoms and healing time during initial outbreaks, as they work by inhibiting viral replication 1.
- It's essential to avoid sexual contact while lesions are present, as the virus is highly contagious during this time.
- If you experience recurrent outbreaks, daily suppressive therapy with these same medications at lower doses may be recommended.
- HSV-1 genital infections typically cause fewer recurrences than HSV-2 infections, but the virus remains in the body permanently.
Management and Prevention
- Accurate diagnosis of genital herpes can be realized using type-specific molecular or virologic tests when genital ulcers are present, and type-specific serologic test to detect antibody when lesions are not present 1.
- Genital herpes can be managed either by episodic antiviral therapy or suppressive antiviral therapy, which can help prevent recurrences and shedding.
- Patient education on the natural history of infection, risk for sexual and perinatal transmission, and methods to prevent further transmission is crucial in managing genital herpes.
From the Research
HSV Type 1 Infection
- HSV type 1 (HSV-1) is a highly prevalent virus that can cause infections in various parts of the body, including the genitals 2.
- Traditionally, HSV-1 has been associated with orofacial infections, but it is increasingly the cause of genital infections, which can manifest as rash or visible skin lesions on the foreskin or penis 2, 3.
Clinical Manifestations
- The clinical spectrum of HSV disease ranges from mild cold sores to severe conditions such as encephalitis or systemic infection, particularly in immunocompromised individuals and neonates 2.
- Genital and labial herpes simplex virus infections are frequently encountered by primary care physicians, and the diagnosis of this condition is often straightforward 4.
- The primary infection results in the appearance of watery blisters (cold sores) on the skin, lips, tongue, buccal mucosa, or genitals 3.
Treatment and Management
- Current treatments, such as acyclovir, target viral DNA polymerase but have limited efficacy and are susceptible to resistance, especially in immunosuppressed populations 2, 5.
- Valacyclovir enhances acyclovir bioavailability compared with orally administered acyclovir and is effective and well tolerated for long-term use in HSV suppression 5.
- Novel drugs such as helicase primase inhibitors (HPIs) are emerging as a promising alternative, showing high efficacy and the potential to overcome resistance 2.