Genital Herpes Simplex

Presentation

The patient may be distraught with severe genital pain, with subsequent outbreak of painful vesicles on the external genitalia that may ulcerate or erode. Alternatively, the patient may just be concerned about paresthesias and subtle genital lesions, may want pain relief during a recurrence, or may be suffering complications such as superinfection or urinary retention. Often, with primary infection, there are associated systemic symptoms such as fever, malaise, myalgias, and headache.

Instead of the classic grouped vesicles on an erythematous base, herpes in the genitals usually appears as groupings of ulcers (2–3 mm in size), representing the bases of abraded vesicles ( Figs. 80.1, 80.2, and 80.3 ). Resolving lesions are also less likely to crust on the genitals. Lesions can be tender and should be examined with gloves on because they shed infectious viral particles. Inguinal lymph nodes may be painful, are usually involved bilaterally, and are not confluent.