Clinical photographs: classical and atypical presentations
Select from these photographs:
1 Classic primary genital herpes in a female
The lesions, which are
usually very painful, begin as small, multiple papules or vesicles, coalesce into large
pustular areas, and then became ulcerated. Mucosal surface lesions re-epithelialise
without crusting. If untreated, virus is shed for a median of 11 days following onset of
lesions but lesions may persist for more than 30 days1.
- View photograph
2 Classic primary genital herpes in a male
The characteristic painful herpetic
vesicles are rarely seen in a first episode because patients present too late. In such
cases, ulcerated or crusted lesions may be present. The primary illness is often less
severe in males than in females with more females presenting with systemic symptoms2.
- View photograph
3 Recurrent episode of genital herpes in a female
With recurrent genital
herpes, the vesicles are usually limited in number and unilateral. Pain is usually less
severe than in primary genital herpes, and the duration of the episode is shorter 1.
- View photograph
4 Atypical genital herpes in a male
Atypical manifestations of
genital herpes are common and include epithelial abnormalities such as fissuring,
furuncles, excoriations and non-specific vulvar erythema and tingling, pain and itching.
Signs in men can include a linear fissure of the prepuce and red spots on the glans penis.
- View photograph
5 Peri-anal genital herpes
Extragenital lesions (e.g.
thigh, buttock, anal regions) occur in 16 per cent of patients with primary genital
herpes, 8 per cent with non-primary genital herpes, and four per cent with recurrent
genital herpes1.
- View photograph
References:
1. Corey L, Adams HG, Brown ZA et al. Genital herpes simplex virus infections:
Clinical manifestations, course and complications. Ann Intern Med 1983; 98:
958-972.
2. Kinghorn GR, Genital herpes: Natural history and treatment of acute episodes, J Med
Virol 1993; (Suppl 1):33-38
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