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:
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.
Urethritis and or/ meatitis may occur and may cause a clear mucoid discharge.
Page last modified: June 3, 2009
Page last reviewed: June 3, 2009
Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention