II. Symptoms: Prodrome (precedes genital lesions by hours to days)

  1. Genital symptoms
    1. Focal, genital pain, Paresthesias, burning, itching
    2. Lesions occur at the perineum, buttock, upper thigh or perianal area
  2. Systemic symptoms
    1. Fever
    2. Headache
    3. Malaise
    4. Myalgias

III. 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

IV. Signs: Adenopathy

  1. Starts during second or third week of disease
  2. Usually bilateral inguinal adenopathy
  3. Slightly enlarged, mildly tender

V. Course

  1. Viral shedding: 15-16 days
  2. Complete lesion healing: 19-21 days

VI. Diagnosis

  1. See HSV Test

VII. 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

VIII. Complications

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Ontology: Primary herpes simplex infection of genitalia (C1274317)

Concepts Disease or Syndrome (T047)
SnomedCT 402888002
English herpes simplex genitalis primary, primary herpes simplex genitalis (diagnosis), primary herpes simplex genitalis, Primary herpes genitalis, Primary herpes simplex infection of genitalia (disorder), Primary herpes simplex infection of genitalia
Spanish infección primaria de genitales por herpes simplex (trastorno), infección primaria de genitales por herpes simplex