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Genital Herpes Simplex Primary and Recurrent InfectionsFirst-episode infections. First-episode infections include true primary infection and nonprimary first-episode infections. Patients with true primary infections have seronegative test results and have never been infected with any type of herpes virus. Patients with nonprimary first-episode infections have been infected at another site with either type 1 or 2 virus (e.g., the oral area) and have serum antibody and humoral immunity. First-episode infections are more extensive and have more systemic symptoms. Viral shedding lasts longer (15 to 16 days) in primary first-episode infections. Virus infections spread easily over moist surfaces. Ten percent to fifteen percent of patients with first-episode genital herpes are simultaneously infected in the pharynx, probably as a result of orogenital contact. They have extensive genital disease and exudative or ulcerative pharyngitis. |