Acute first episode infection occurs 6 days after contact with an infected person. Infection is usually acquired from an asymptomatic individual who is unaware that they are shedding the virus. This patient who has never had genital herpes becomes ill. Fever, headache and malaise develop. Vesicles on a red base rapidly appear and may occur over a wide area of the vulva, vaginal tract, penis, scrotum and pelvic skin. Vesicles are quickly macerated in the intertriginous areas of the vulva. Therefore physical examination of this area shows only erosions.
Vesicles evolve into erosions and eventually form crusts and are gone in 2-3 weeks. There is unilateral or bilateral tender inguinal adenopathy.
Patients who have experienced an episode of acute herpes will almost always have recurrent disease. Itching, burning or pain heralds the onset of a recurrence. The same cycle of lesions as occurred in the acute disease occurs again. Vesicles form then rapidly erode, crust then heal. These recurrences may continue for years at a variable frequency. Many women are unaware of recurrences in the vagina or vulva because they are asymptomatic and out of site.
Many individuals learn what they’re prodromal symptoms are and will initiate suppressive therapy at the earliest sign of recurrence.