Genital Herpes Simplex Signs and Symptoms
Vesicles appear about 6 days after sexual contact. Vesicles become depressed in the center (umbilicated) in 2 or 3 days then erode. Crusts form and the lesion heals in the next week or two. Scars form if the inflammation has been intense. Discharge, dysuria, and inguinal lymphadenopathy are common. Systemic complaints including fever, myalgias, lethargy, and photophobia are present in approximately 70% of patients and are more common in women. The clinical diagnosis is insensitive and nonspecific. The typical painful multiple vesicular or ulcerative lesions are absent in many infected persons. Women have more extensive disease and a higher incidence of constitutional symptoms probably because of the larger surface area involved. Wide areas of the female genitals may be covered with painful erosions. The cervix is involved in most cases, and erosive cervicitis is almost always associated with first-episode disease. The virus can be isolated from the cervix in only 10% to 15% of women with recurrent disease. Inflammation, edema, and pain may be so extreme that urination is interfered with and catheterization is required. The patient may be immobilized and require bed rest at home or in the hospital. A similar pattern of extensive involvement, with edema and possible urinary retention, develops in males, especially if uncircumcised. Crusts do not form under the foreskin. The eruption frequently extends onto the pubic area, and it is possibly spread from secretions during sexual contact. The anal area may be involved after anal intercourse. Nearly 40 percent of newly acquired HSV-2 infections and nearly two thirds of new HSV-1 infections are symptomatic. Among sexually active adults, new genital HSV-1 infections are as common as new oropharyngeal HSV-1 infections.
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