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3-Recurrent Herpes labialis A prodrome of pain, burning & tingling Followed by the development of erythematous papules that rapidly develop into tiny, thin-walled, intraepidermal vesicles that become pustular and ulcerate In most patients, fewer than 2 recurrences each year, but some individuals have monthly recurrences Maximum viral shedding is in the first 24 hours of the acute illness but may last 5 days. 4-Primary genital herpes Primary genital herpes can be caused by both HSV-1 and HSV-2 Recurrences are more common with HSV-2 Asymptomatic in most patients Primary genital herpes is characterized by severe and prolonged systemic and local symptoms. Clinical features in men Herpetic vesicles appear in the glans penis, the prepuce, the shaft of the penis, and sometimes on the scrotum, thighs, and buttocks In dry areas, the lesions progress to pustules and then crust Herpetic urethritis occurs in 30-40% of patients and is characterized by severe dysuria and mucoid discharge The perianal area and rectum can be involved in persons who engage in anal intercourse, resulting in herpetic proctitis. Clinical features in women Herpetic vesicles appear on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus In moist areas, the vesicles rupture, leaving exquisitely tender ulcers The vaginal mucosa is inflamed and edematous. In men and women, the ulcerative lesions persist from 4-15 days until crusting and reepithelialization occur The median duration of viral shedding is about 12 days.


Subclinical genital herpes The majority of primary genital HSV infections are asymptomatic and 70%-80% of seropositive individuals have no history of symptomatic genital herpes Nevertheless, they experience periodic subclinical reactivation with virus shedding, thus making them a source of infection The rate of viral shedding may be 1-2%. Tzanck smear is a time-honored procedure to assist in the diagnosis of cutaneous herpesvirusinfections Typically, an intact vesicle is used from which the vesicular fluid is aspirated After aspiration, the vesicle should be unroofed aseptically.Using a sterile instrument, the floor of the newly produced ulcer can then be scraped. Staining can be performed with a Papanicolaou stain,Gram or Giemsa A positive result is the finding of multinucleate giant cells. Umbilicated vesiculopustules that progress to punched-out erosions The eruption is most commonly disseminated in the areas of dermatitis, with a predilection for the head& trunk. Pain may subside in 2-3 w in young patients but may last for 1 m in the elderly Pain lasting longer than 1-3 months is referred to as postherpetic neuralgia.


Following resolution of the chickenpox, the virus lies dormant in the dorsal root ganglia until focal reactivation along a ganglion's distribution results in herpes zoster Although the exact precipitants that result in viral reactivation are not known certainly, decreased cellular immunity appears to increase the risk of reactivation.



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