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Herpes genitalis is a sexually transmitted disease usually caused by herpes simplex virus type II (occasionally by type I). The incubation period for herpes infection is 2 -14 days, with first episodes often lasting 2-4 weeks. Typically, symptoms are most pronounced during this primary episode and include grouped painful skin vesicles and multiple shallow skin ulcers in the genital area, along with inguinal lymphadenopathy and fever. In women, local symptoms may include vaginal discharge, vulval pain, dysuria and vaginal bleeding.
The herpes virus remains latent in the host after first infection with recurrent episodes a frequent feature over several years. These may be triggered by stress, menstruation or sexual intercourse, but tend to be of shorter duration and are only rarely accompanied by fever and lymphad enopathy. Neonatal herpes infection occurs in about half the infants delivered vaginally to mothers suffering from either primary or recurrent infection and is associated with significant morbidity and mortality.
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Diagnosis can be assisted by demonstrating multinucleated giant cells on Giemsa staining from the swab of the base of a fresh vesicle. Rapid antigen testing can be used; serological tests are also available, but are generally negative during a primary attack. Although herpetic infections are notoriously resistant to treatment, antiviral agents such as acyclovir can be used episodically to speed healing during an attack or can be used as suppressive therapy to aid prevention of recurrences. Other infections such as candidosis commonly occur as a result of the immunosuppressive effect of the virus and necessitate treatment with an antifungal cream.
This particular photograph is of a 32 year old, sexually active woman who presented with 'agony' dysuria. This 'agony' is virtually diagnostic of herpetic infection. Examination of the external genitalia revealed severe herpetic vulvitis. Note the presence of shallow ulceration along with vulvar oedema.
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