Clinical Manifestations and Sequelae (continued)

First Clinical Episode (Primary Infection)

The first clinical episode of a primary HSV infection is characterized by the occurrence of numerous bilateral painful genital lesions. Lesions last an average of 11-12 days (full re-epithelialization takes an average of 17-20 days). Typical lesion progression:

papules --> vesicles --> pustules --> ulcers --> crusts --> healed

The median duration of viral shedding (from the onset of lesions to the last positive culture) is ~12 days, and correlates well with the mean time from the onset of vesicles to crusting.

Systemic symptoms peak within 3-4 days of onset of lesions and gradually recede over the next 3-4 days. Local symptoms include pain, itching, dysuria, vaginal or urethral discharge, and tender inguinal adenopathy.

HSV cervicitis occurs in 70-90% of primary HSV-2 infections and about 70% of primary HSV-1 infections.  It may involve the exo- or endocervix and may be symptomatic or asymptomatic. In most cases, the cervix appears abnormal to inspection with ulcerative lesions, erythema, or friability.

Herpes proctitis may occur, manifesting with pain, discharge, tenesmus, constipation with or without symptoms of autonomic dysfunction, and severe ulceration on anoscopy.

Urethritis and or/ meatitis may occur and may cause a clear mucoid discharge.

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