This 22-year-old man complained of a painful blistering eruption on his penis. He recovered fully after treatment with oral acyclovir 400 mg orally 5 time a day for 10 days. Serologic tests for syphilis and Human Immunodeficiency virus infection were negative. There are two main types of herpes simplex virus (HSV), HSV Type 1, which is mainly associated with facial infections (cold sores or fever blisters) and HSV Type 2, which is mainly genital (genital herpes). First or primary attacks of Type 1 infections occur mainly in infants and young children and are usually mild or subclinical. Type 2 infections occur mainly after puberty and are usually transmitted sexually. The initial infection more commonly causes symptoms. These viruses cause lifelong infection with potential for reactivation or recurrence. Often people refer only to HSV-2 when discussing genital herpes, but both types can cause infection in the genital area. Clinically, about 60-70% of primary genital infections are due to HSV-2 with the rest due to HSV-1. Infection with Type 2 HSV typically occurs after the onset of sexual activity and results in genital herpes. Penile ulceration from herpetic infection is the most frequent cause of genital ulceration seen in sexual health clinics. The ulcers are most frequent on the glans, foreskin and shaft of the penis. They are sore or painful and last for 2 to 3 weeks if untreated.
In the female, similar lesions occur on the external genitalia and the mucosae of the vulva, vagina and cervix. Pain and difficulty passing urine are common. Infection of the cervix may progress to a severe ulceration.
Recurrences of Type 2 infection may also occur on any site but most often affect the genitals or buttocks. Recurrent HSV tends to always affect the same region, but not necessarily the identical site.
Itching or burning is followed an hour or two later by small, closely grouped vesicles on a red base. They normally heal in 7-10 days without scarring. Generally the affected person feels quite well but they may suffer from fever, pain and have enlarged lymph nodes nearby.
