Genital herpes is a lifelong infection with herpes simplex virus type 2 or type 1 that causes recurring painful blisters and ulcers. The virus can spread even without visible sores, so counseling and suppressive therapy are key parts of care.
Key symptoms
- Tingling or burning before sores appear
- Clusters of painful blisters that break into shallow ulcers
- Painful urination
- Fever, body aches and headache in the first episode
- Recurrences are usually milder and shorter
What you find on exam
- Grouped vesicles on a red base, or shallow painful ulcers
- Tender swollen lymph nodes in both groins
- Full bladder from urinary retention
- Cervical or rectal lesions on exam
- Look for signs of other sexually transmitted infections
Tests
- HSV PCR (NAAT) from a fresh, unroofed lesion
- Type-specific HSV blood tests in selected cases, not for routine screening
- Test for syphilis, HIV, gonorrhea and chlamydia
- Pregnancy test if relevant
Treatment basics
- First episode: acyclovir, valacyclovir or famciclovir for 7 to 10 days
- Recurrences: short course started at the first tingle
- Daily suppressive valacyclovir to cut outbreaks and transmission
- Condoms, and no sex while sores or symptoms are present
- Pregnancy: suppressive therapy from 36 weeks; cesarean if lesions at labor
Red flags
- Headache, stiff neck or confusion
- Unable to pass urine
- Genital lesions in late pregnancy or during labor
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.