The first episode of herpes after initial infection is known as the primary outbreak, characteristically appearing with flu-like symptoms such as fever, headache, and swollen lymph glands in the groin (Table Symptoms of Herpes According to Type of Outbreak). Primary outbreaks can last 2 to 3 weeks and can be severe enough in rare cases to require hospitalization. Recurrent herpes outbreaks are commonly heralded by a prodromal stage with characteristic feelings of tingling or itching in the genital area or around the mouth, pain and tingling in the groin, and possibly in the buttocks and backs of the thighs. Virus is already present on the skin in the prodromal phase, so this is considered a contagious phase although blisters are not yet visible. The prodromal phase typically lasts 1 to 3 days followed by vesicles, lesions, and scabbing lasting for up to 10 days before complete healing has occurred. Recurrent outbreaks are often mild and may present with pruritus, local tingling or pain, slight vaginal discharge but present with no generalized systemic symptoms. Small sores or vesicles can occur anywhere on the skin or mucous membranes of the mouth anogenital region, and are most common around the mouth and genital area. The vesicles break and become wet, finally crusting over. Healing is complete when new skin is formed under the scab, which falls off. Rarely, focal necrosis, ballooning degeneration of skin cells, and other histopathologic changes can result.
Symptoms of Herpes According to Type of Outbreak
|Primary outbreak||• This is the initial outbreak after infection; if patients do not notice vesicles, a primary outbreak may be dismissed as “flu.”
• Characterized by systemic infection commonly with fever and aching
• May last 2 to 3 weeks
• Frequently accompanied by lym-phadenopathy
• Appearance of clusters of vesicles on an erythematous base that develop into ulcers that crust over and heal
• Severe primary outbreak can cause serious infection, including encephalitis, and may require hospitalization
|Recurrent episodes||• Immunocompromised patients may develop especially severe symptoms
• Symptoms of tingling and itching or perineal aching may precede the appearance of vesicles and lasts 1 to 3 days. Note that virus is already present on the skin during this stage.
• Vesicles appear and last up to 10 days until full healing.
|Subclinical infection||• Asymptomatic with viral shedding|
Most patients are mistakenly thought to be silent carriers. At least 90% of herpes simplex virus-2 carriers are ignorant of their conditions with up to 60% to 75% having unrecognized signs and symptoms of genital herpes. Commonly, symptoms are falsely attributed to other more casual urogeni-tal problems. Because herpes is a self-healing condition, with symptoms easily controlled with topical nonspecific agents, the diagnosis is not frequently made. The following are examples of the conditions to which female patients attribute what are actually symptoms of genital herpes outbreaks:
- • Vaginitis
- • Allergies or reactions to medications, toilet paper, sanitary pads or other menstrual products, soaps, condoms
- • Lack of lubrication during sex
- • Excessively frequent sexual intercourse
- • Irritation from tight jeans, g-string, bicycle seats
- • Urinary tract infections
- • Vaginal dryness
- • Shaving burns
- • Reactions to hair removal products
- • Hemorrhoids or anal fissures