Slide 1
Multiple, small lesions in primary HSV infection

In a patient who has not previously been exposed to either HSV-1 or HSV-2 in a non-genital site (peri-orally or digitally), the manifestations of a first acquisition of HSV in the genital area are generally accompanied by both systemic and local manifestations. Usually, the onset of symptoms occurs between 2 and 14 days after transmission. Fever, malaise, flu-like symptoms including headache, myalgia and meningism typically precede the appearance of genital lesions.

The diagnosis of genital herpes is usually made clinically and treatment using an oral antiviral should be instigated promptly. Confirmatory laboratory diagnosis should be made by virus culture and typing or polymerase chain reaction (PCR). It is important that screening tests for other sexually transmitted pathogens are also undertaken, including tests for urethral gonorrhoea and Chlamydia trachomatis infection; dark ground examination and follow-up serology for syphilis and, where appropriate, testing for HIV and hepatitis infections.