II. History: Prodrome (occurs in 50% of cases, hours to days before lesions)

  1. Focal genital Paresthesias, dysesthesia, numbness

III. Signs

  1. Lymphadenopathy: slight, mildly tender
  2. Vessicles ulcerate and then crust
    1. Solitary or 3-4
    2. Enlarges over 3-4 days
    3. Peaks at 4-8 days

IV. Diagnosis

  1. See HSV Test

V. Course

  1. Viral shedding during first 3-4 days
  2. Recurrence: 5-8 episodes per year

VI. Management: Episodic (Start within 24 hours of first symptoms):

  1. Acyclovir
    1. Acyclovir 200 mg orally five times daily for 5 days or
    2. Acyclovir 400 mg orally three times daily for 5 days or
    3. Acyclovir 800 mg orally twice daily for 5 days or
    4. Acyclovir 800 mg orally three times daily for 2 days
      1. Two day regimen as effective as 5 day
      2. Wald (2002) Clin Infect Dis 34:944-8 [PubMed]
  2. Famciclovir
    1. Famciclovir 125 mg orally twice daily for 5 days or
    2. Famciclovir 250 mg orally twice daily for 2 days (500 mg for first dose) or
    3. Famciclovir 1000 mg orally twice daily for 1 day
  3. Valacyclovir
    1. Valacyclovir 500 mg orally twice daily for 3 days or
    2. Valacyclovir 1000 mg orally once daily for 5 days

VII. Management: Suppression/Prophylaxis

  1. Indications for suppression
    1. More than 6 episodes per year
    2. Consider for disabling episodes less often
  2. Acyclovir
    1. Acyclovir 400 mg orally twice daily or
    2. Acyclovir 200 mg orally three to five times daily
    3. Duration
      1. Typically used for 12 months (Appears safe for up to 6 years)
      2. Consider as prophylaxis at stress times
    4. Effiacy
      1. Decreases episodes from 11.4 to 1.8 per year
      2. Kaplowitz (1991) JAMA 265:747-51 [PubMed]
  3. Famciclovir
    1. Famciclovir 250 mg orally twice daily
  4. Valacyclovir
    1. Valacyclovir 500 to 1000 mg orally daily
    2. Efficacy
      1. Reduces HSV-2 transmission to partner by 50%
      2. Corey (2004) N Engl J Med 350:11-20 [PubMed]

VIII. Course

  1. Recurrence rate: Four episodes per year
  2. Factors predictive of more frequent recurrences
    1. Severe primary outbreak
    2. Male gender
    3. More frequent initially, decrease over time
    4. Exposure to provocative factors
      1. Fever
      2. Trauma
      3. Stressful situations
      4. Heat or cold extreme exposure
      5. Immunocompromised
      6. Menses

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Ontology: Recurrent genital herpes simplex (C1274323)

Concepts Disease or Syndrome (T047)
SnomedCT 402894005
English genital herpes recurrent, recurrent genital herpes, Recurrent genital herpes simplex (diagnosis), herpes simplex genitalis recurrent, Recurrent genital herpes simplex (disorder), Recurrent genital herpes simplex, Recurrent herpes genitalis
Spanish herpes simplex genital recurrente (trastorno), herpes simplex genital recurrente