Frequency of Fever in Primary Genital HSV
Approximately two-thirds (67%) of patients with primary first-episode genital herpes develop systemic symptoms including fever. 1
Fever and Systemic Symptoms in Primary Genital HSV
The landmark study by Corey and colleagues provides the most specific data on fever frequency in primary genital herpes:
- 67% of patients with primary first-episode genital herpes experienced systemic symptoms, which typically include fever, headache, malaise, and myalgia 1
- Women tend to experience more severe systemic symptoms than men with primary infection 1
- The systemic symptoms occur alongside local manifestations including pain and itching (98%), dysuria (63%), and tender adenopathy (80%) 1
Distinguishing Primary from Recurrent Episodes
The presence of fever is a key distinguishing feature between primary and recurrent genital herpes:
- Primary episodes: Systemic symptoms including fever are common (67% of cases) 1
- Recurrent episodes: Systemic symptoms are uncommon, and 25% of recurrent episodes are completely asymptomatic 1
- Primary infections show more extensive disease, greater viral shedding, and more pronounced systemic manifestations compared to recurrent infections 2
Clinical Context and Severity
Primary genital herpes represents the most severe clinical presentation:
- Lesions in primary infection last a mean of 19.0 days, compared to 10.1 days for recurrent episodes 1
- Multiple bilateral pustular ulcerative lesions characterize primary infection 1
- Some patients with severe primary disease may require hospitalization 3
Important Clinical Pitfall
Do not assume absence of fever rules out primary genital herpes, as approximately one-third of primary infections do not present with systemic symptoms 1. The diagnosis should be confirmed by viral culture or PCR rather than relying solely on the presence or absence of fever 3.