Clinical manifestations and symptoms The primary lesion of an HSV infection is a group of multiple clear vesicles on erythematous skin or mucosa. After one to three days vesicles become pustular, and finally erode to become painful shallow erosions with a yellow floor and red edge. In primary genito-anal herpes infection there is also tender inguinal lymphadenopathy and sometimes malaise, myalgia and headache. There can be intense genital pain and dysuria. Crusting and healing occurs after one to three weeks.
Recurrences occur in some patients, generally lasting only a few days, with less severe lesions.
Anywhere on the penis, scrotum, vulva, vagina, cervix or perianal area. Epidemiology Common world-wide in both sexes. Primary infection with HSV type 1 usually occurs on the face in childhood, and confers partial immunity against later genital infection occurring in adolescence and young adulthood. Greater prevalence in lower socio-economic groups, and in people with multiple partners. Lesions on perianal skin or in the anal canal are more common in homosexual men.