Primary Genital Herpes

Aka: Primary Genital Herpes, Acute Genital Herpes, Initial Genital Herpes

1. See Also
   1. Genital Herpes in Pregnancy
   2. Genital Herpes
   3. Secondary Genital Herpes
   4. Genital Ulcer
   5. Sexually Transmitted Disease
2. Symptoms: Prodrome (precedes genital lesions)
   1. Fever
   2. Headache
   3. Malaise
   4. Myalgias
3. Signs: Skin Lesions
   1. Lesion development
      1. Starts as shallow Vesicle
      2. Umbilicates with central depression
      3. Ulcerate early in course
      4. Crusts and then re-epitheliazes without scarring
   2. Multiple, grouped lesions are common and may coalesce
   3. Very painful on Ulceration
   4. Present for 4-15 days
4. Signs: Adenopathy
   1. Starts during second or third week of disease
   2. Usually bilateral inguinal adenopathy
   3. Slightly enlarged, mildly tender
5. Course
   1. Viral shedding: 15-16 days
   2. Complete lesion healing: 19-21 days
6. Diagnosis
   1. See HSV Test
7. Management
   1. See Genital Herpes in Pregnancy
   2. See Genital Herpes
   3. Outpatient
      1. General
         1. Shortens duration of pain and period of viral shedding
      2. Acyclovir
         1. Acyclovir 400 mg orally three times daily for 7-10 days or
         2. Acyclovir 200 mg orally five times daily for 7-10 days
      3. Famciclovir 250 mg orally three times daily for 7-10 days
      4. Valacyclovir 1000 mg orally twice daily for 7-10 days
   4. Inpatient
      1. Indications: Severe or complicated Herpes Simplex Virus Infection
         1. HSV-related hepatitis
         2. HSV Encephalitis
         3. HSV pneumonitis
      2. Protocol
         1. Acyclovir 5-10 mg/kg IV q8h for 2 to 7 days
         2. Convert to oral agents when able
8. Complications
   1. Aseptic Meningitis
      1. Occurs in 15% with Primary Genital Herpes
   2. Mollaret's Meningitis
      1. May present with inability to urinate, as well as paralysis and Paresthesias
   3. Sacral radiculopathy syndrome
      1. Sacral anesthesia, Urinary Retention
      2. May last up to 8 weeks
   4. Extragenital lesions
      1. Autoinoculation of buttocks, hands, eyes
   5. Transverse myelitis
   6. HSV Hepatitis (rare)
      1. Acute life-threatening hepatitis with high mortality rate
9. References
   1. Beauman (2005) Am Fam Physician 72(8):1527-34
   2. Kimberlin (2004) N Engl J Med 350(19): 1970-7
   3. Nadelman (2000) Postgrad Med 107(3):189-95