The clinical presentation depends on the type of infection; the primary genital herpes is characterized by severe, prolonged symptoms. The incubation period ranges from 1 day to 3 weeks. The general symptoms are seen most commonly on first 3-4 days, which includes fever, malaise, headache, muscle pain. Also, locally there is pain, dysuria, itching, vaginal and urethral discharge and tender lymph nodes [6].

In women, the herpetic eruption is seen on external genitalia. Cervix is involved about 70-80% of the times. It is red, edematous and painful. There is dysuria which can cause urine retention and urethritis. HSV is isolated in the urine when tested. The moistness of the genital area makes the vesicles rupture leaving an ulcer which is painful.

In men, the herpetic vesicles are found on glans penis, shaft of penis; the prepuce and scrotum may be involved. The buttocks and the thighs are also not spared. It causes herpetic urethritis and herpetic prostatitis when involving rectum and perianal area. Women are affected more severely than men.

Recurrence is common especially in patients with severe primary infection. There is prodrome in which the patient experiences pain, burning and tenderness at the site of eruption. The lesion may heal in 7-10 days. The symptoms are again more severe in women than men [7].

• Inguinal Lymphadenopathy

  Patients also may have constitutional symptoms such as headache, fever, inguinal lymphadenopathy, anorexia, and malaise. 7 As the disease progresses, papules, vesicles on an erythematous base, and erosions appear over hours to days. [aafp.org]

• Malaise

  The general symptoms are seen most commonly on first 3-4 days, which includes fever, malaise, headache, muscle pain. Also, locally there is pain, dysuria, itching, vaginal and urethral discharge and tender lymph nodes. [symptoma.com]

  Symptoms of primary infection may include malaise, fever, or localized adenopathy. Subsequent outbreaks, caused by reactivation of latent virus, are usually milder. Asymptomatic shedding of transmissible virus is common. [ncbi.nlm.nih.gov]

  Generalized symptoms such as fever and malaise may develop, and lymph nodes in the groin may enlarge. Lesions may persist in this stage for a week or more, and complete healing may take four to six weeks. [britannica.com]

  Primary (first time) genital HSV1 and HSV2 are characterised by ‘systemic’ symptoms, fever, headache and malaise. These symptoms are usually worse within the first few days of the appearance of the rash, and gradually recede in 3-4 days. [stdclinic.ie]

  Fever and a general feeling of illness (malaise) are common, and some people have burning during urination, difficulty urinating, or constipation. Some people have no symptoms. [msdmanuals.com]

• Pathologist

  Patients and especially children require neuro-rehabilitation which includes collaboration between neurologist, physiotherapist, psychiatrist, and speech-language pathologist. [remedypublications.com]

• Intravenous Administration

  The treatment was performed by intravenous administrations of dexamethazone (initial dose 24 mg/24 h, 27 days), mannitol 10%, Human-Albumin 20% 100 ml (5 times), immunovenin 50 ml (7 times ), glucose and saline solutions, ceftriaxone (2g twice daily intravenously [remedypublications.com]

• Diarrhea

  Adverse effects are infrequent with oral administration but may include nausea, vomiting, diarrhea, headache, and rash. Topical antiviral drugs have only little value, and their use is discouraged. [msdmanuals.com]

  Side effects include abdominal pain, diarrhea, dizziness, nausea, vomiting, and headache. Drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication. [medicinenet.com]

• Perianal Ulcer

  Sexually Transmitted Disease Treatment Guidelines: Diseases Characterized by Genital, Anal, or Perianal Ulcers. Available online at http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#hsv. Page last reviewed January 28, 2011. [labtestsonline.it]

  Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N. Engl. J. Med. 1981; 305 :1439–1444. [ PubMed : 6272110 ] Smith J. S., Herrero R., Munoz N., et al. [ncbi.nlm.nih.gov]

• Skin Ulcer

  When symptoms appear, they can include: Itching, burning, soreness and small blisters in the genital or anal area Small ulcers (skin sores) when the blisters break Local pain if urine touches the genital ulcers Enlarged or painful lymph nodes (swollen [drugs.com]

  Even normal appearing skin can spread the infection. Clothing that touches genital skin ulcers may transmit herpes simplex virus to others that wear the clothing. [medicinenet.com]

• Chancre

  HSV-1 occurs most often on or near the mouth and appears as a chancre or cold sore. The second type, herpes simplex type 2 (or HSV-2), occurs most often on or near the sex organs and is sometimes called “genital herpes.” [my.clevelandclinic.org]

  It may also be mistaken for other genital conditions, including fungal infections, and the chancre (ulcer) of primary syphilis. Primary (first time) genital HSV1 and HSV2 are characterised by ‘systemic’ symptoms, fever, headache and malaise. [stdclinic.ie]

  The Act named syphilis, gonorrhoea and soft chancre (or chancroid) as dangerous diseases for which free treatment was to become compulsory. Genital herpes did not get a look in. [spiked-online.com]

• Vaginal Discharge

  Symptoms include blisters, ulcers, pain when urinating, cold sores, and vaginal discharge. Although there is no cure for herpes, it can be treated using medications and home remedies. [medicalnewstoday.com]

  Generalised symptoms include: itching or tingling, burning, or pain painfulrred spots/sores that change to clear fluid-filled blisters redness or a rash around the genital area swelling of the genital area pain while peeing flu-like symptoms vaginal discharge [health.govt.nz]

  Early signs of genital herpes include: Itching or burning sensation in the genital region Symptoms similar to flu, such as fever, a sore throat and generally feeling unwell Inflamed glands Vaginal discharge Pain in the genital region, buttocks and legs [medic8.com]

  Other frequent symptoms are painful urination, urethral or vaginal discharge and swollen lymph nodes. The first exposure or primary episode consists of headache, fever, chills and muscular weakness. [health.ny.gov]

• Genital Lesions

  Most initial infections do not cause symptoms, but primary genital lesions are usually more painful, prolonged, and widespread than recurrent genital lesions. [msdmanuals.com]

  The severity of HSV infection in the newborn has always dictated conservative management when prodromal symptoms or active genital lesions (or those suggestive of genital herpes) are present during labor and delivery. [ncbi.nlm.nih.gov]

• Chancroid

  The Act named syphilis, gonorrhoea and soft chancre (or chancroid) as dangerous diseases for which free treatment was to become compulsory. Genital herpes did not get a look in. [spiked-online.com]

  Differential Diagnosis of Genital Ulcers Infectious Chancroid Fungal infection Genital herpes simplex Granuloma inguinale Lymphogranuloma venereum Secondary bacterial infection Syphilis Noninfectious Aphthous ulcers Behçet syndrome Fixed drug eruption [aafp.org]

  Genital ulcers can also be caused by syphilis, chancroid or lymphogranuloma venereum, and testing for these should be considered. Testing for other STIs, including chlamydia and gonorrhea, should be considered. [phac-aspc.gc.ca]

  For example, estimates of the incidence of chancroid could be based on numbers of reported clinical cases, because chancroid has characteristic clinical features and is a disease for which asymptomatic infection is uncommon. 17 For other infections where [who.int]

  Other diseases which may cause genital sores are syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, herpes zoster, erythema multiform, Behçet's syndrome, inflammatory bowel disease, contact dermatitis, candidiasis, and impetigo. [medical-dictionary.thefreedictionary.com]

• Dyspareunia

  For patients who are symptomatic, common symptoms include painful ulceration in the anogenital region, vaginal or urethral discharge, superficial dyspareunia and external dysuria. Up to a third of patients experience painful lymphadenitis. [prescriber.co.uk]

The diagnosis is based on the examination of the patient and the signs and symptoms given by him/her. Tissue culture is the confirmatory test to establish the diagnosis of infection with herpes. The isolation of virus is best done within 48 hours of inoculation. The herpes lesion can be seen under the microscope within an hour for the histological appearance of herpes. The eosinophillic intra nuclear inclusion bodies in multi nucleated giant cells and epithelial cells are characteristic of herpes. Polymerase chain reaction technique is used to detect HSV DNA [8].

Specific antivirals are given to treat the lesion. Nucleoside triphosphate is administered to inactivate HSV polymerase. Acyclovir is given empirically to all the patients with HSV infection.

However, in immune compromised individuals and patients with HSV Encephalitis, high doses of Acyclovir are given intra venously [9].

The general symptoms like fever, malaise are treated symptomatically. Proper care of the wound is to be done and secondary bacterial or fungal infection should be treated. The dermatologist should be taken into consultation.

Prognosis is bad as once infected with HSV, the chances of recurrence are very high. If antiviral therapy is administered in time the disease may resolve quickly. Also, one must maintain a strong immunity to reduce the chances of recurrence.

Genital Herpes is caused by Herpes Simplex Virus 1 and 2. Out of these, HSV-1 is usually associated with orofacial disease and HSV-2 is associated with genital disease. There are three types of clinical HSV infection: primary, non primary and recurrent [1].

Primary infection: in which there is no serological evidence of previous infection with neither HSV 1 nor 2 and it is a newly acquired infection.

Non-primary, first episode: occurs when there has been a history of previous infection with some other form of herpes and there is a newly acquired genital herpes. Primary and non-primary infection usually occurs due to unprotected sex with the infected partner, frequent change of sexual partners, previous infection with sexually transmitted disease, impaired immunity due to immune compromised disease like HIV/AIDS.

Recurrent: in this there is recurrence of same type of HSV infection again. HSV2 is more common. It usually occurs when the patient is stressed, tired and menstruating. Recurrence is also seen when the immunity is low due to HIV infection and in immune compromised individual due to organ transplant or stem cell transplantation [2].

Genital Herpes is seen worldwide. It is more common between ages 18 to 45 which correlate directly with sexual activity. Also, it is seen more frequently in lower socioeconomic groups. It is more prevalent in women than men [3].

Herpes Simplex Virus 1 and 2 are the cause of genital herpes. However, infection with HSV 2 is the common cause of genital herpes. HSV is a double stranded DNA virus which has the capacity to replicate in the nervous system. The genital herpes virus infects the sacral nerve root ganglia [S2-S5].

Human beings are the natural reservoir of this virus and the person in close contact with such an infected individual gets affected due to unprotected sex. The virus gets inoculated on the mucosal surface of cervix or through the cracked skin into the host. It can be transmitted via mother’s genital tract to the new born baby during the process of delivery [4] [5].

Herpes virus is so common in the metropolitan city that it is extremely difficult to avoid it. One can prevent it by avoiding contact with infected individuals who shed the virus in salivary or genital secretion. One can use condom to prevent it. However, you can acquire it if it is found outside the area covered by condom. Also, oral contact and oro genital contact should be avoided. Caesarean section is advised to the women who have genital herpes at the time of delivery. One must increase the immunity to decrease the chances of recurrence. Antiviral therapy should be taken. However therapies to suppress the infection and HSV vaccine are still under trials [10].

Genital Herpes is a fairly common ulcerative disease which is seen around the world. It is caused by Herpes Simplex Virus (HSV). Most often patients remain asymptomatic. However, lymphadenopathy and systemic symptoms do occur. There are three types of clinical infections.

Diagnosis is done by clinical history followed by serological test, polymerase chain reaction and viral culture. Recurrence is common but its intensity can be reduced by administrating oral anti virals. One must avoid sexual intercourse when symptomatic.

Genital herpes is caused by herpes simplex virus (HSV) 1 and 2. Infection with HSV 2 is more common. The patient may acquire infection through an infected person by coming in contact with the saliva or genital secretion of such person. The neonate is infected through the infected mother who passes the virus through the genital tract to the baby during delivery. The patient may be asymptomatic or may have symptoms of pain, malaise, fever, headache, painful urination with retention.

The lesion may be seen anywhere around and in the genital region of the male or female who are infected. Females tend to have more severe symptoms than men. Treatment includes symptomatic care and antiviral therapy.

It can be prevented by avoiding contact with the infected individual and wearing condom can minimize the risk of exposure. A healthy immunity decreases the chances of infection. HSV vaccine is still under research.

1. Corey L. Herpes Simplex Virus. In: Mandell Gl, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Pennsylvania: Elsevier; 2005:1762-80.
2. Corey L, Wald A, Celum CL, Quinn TC. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. J Acquir Immune Defic Syndr. 2004 Apr 15;35(5):435-45.
3. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997 Oct 16;337(16):1105-11
4. Benedetti JK, Zeh J, Corey L. Clinical reactivation of genital herpes simplex virus infection decreases in frequency over time. Ann Intern Med. 1999 Jul 6;131(1):14-20.
5. Gardella C, Brown ZA, Wald A, Morrow RA, et al. Poor correlation between genital lesions and detection of herpes simplex virus in women in labor. Obstet Gynecol. 2005 Aug;106(2):268-74.
6. Kimberlin DW, Rouse DJ. Clinical practice. Genital herpes. N Engl J Med. 2004 May 6;350(19):1970-7.
7. Corey L, Adams HG, Brown ZA, Holmes KK. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Ann Intern Med. 1983 Jun;98(6):958-72.
8. Wald A, Zeh J, Selke S, Ashley RL, Corey L. Virologic characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med. 1995 Sep 21;333(12):770-5.
9. Johnston C, Saracino M, Kuntz S, Magaret A et al. Standard-dose and high-dose daily antiviral therapy for short episodes of genital HSV-2 reactivation: three randomized, open-label, cross-over trials. Lancet. 2012 Feb 18;379(9816):641-7.
10. Belshe RB, Leone PA, Bernstein DiIet al. Efficacy Results of a trial of a herpes simplex vaccine. N Engl J Med. 2012;366:34-43.