Painful single or multiple vesicular or ulcerative lesions present in the genitals, buttocks or groin area of men or women, also:
- Itching, pain, swelling, burning or redness prior to lesions appearance, anywhere in the genital area, buttocks or groin.
- Fever, chills, nausea, tiredness, muscle aches and headaches.
- Dysuria - mild to very severe, depending on location of lesion(s).
- An increase in discharge - usually very runny.
- Swollen lymph nodes, usually inguinal and tender on palpation.
- Complaints of shooting pain through the buttock, occasionally radiating down one or both legs.
- Complaints of pain at lesion(s), sometimes so severe client can barely stand the pressure of her undergarments.
- History of recurrent lesions at or near the same sight.
- Client states her partner is an HSV carrier.
- Complaints of itching, burning, tingling or redness several days before the onset of lesions anywhere in the genital area including the penis, scrotum, pubis, rectum, thighs or buttocks.
- Possible fever, chills, aching, tiredness, and nausea.
- Swollen inguinal lymph nodes - usually not as painful as the nodes of the female.
- Complaints of pain at the site of lesions sometimes so tender that undergarments cause severe pain.
- History of recurrent lesions at or near the same site.
- Client states his partner is an HSV carrier.
Laboratory confirmed HSV-2 (identification of HSV in a genital lesion or genital secretions by culture, an approved immunochemical method, or PCR, AND/OR serology: only selected commercially available glycoprotein G-based type-specific serological tests (e.g., HerpeSelectTM, POCkitTM) or Western blot reliably differentiate HSV-2 from HSV-1 antibody)
Screening for the general population is not indicated. Consider testing patients if:
- They have genital sores
- They have a partner with genital herpes
- They are seeking STD evaluation (especially if they have multiple sex partners)
- They are infected with HIV
- They are an MSM at increased risk for HIV acquisition
- Viral Culture - within the first 48 hours after a lesion appears, higher false negative rate afterwards
- HSV DNA PCR - swab symptomatic area; more sensitive than culture
Recommended, with reservations:
- IgG - 12-16 weeks from last exposure
- Test kits are available through referral laboratories. Testing/test kit availability may vary by laboratory.
First Clinical Episode
Begin treatment within 6 days of prodrome with one of the following:
Valacyclovir- (Valtrex) 1 gram. #20. One tablet 2 times daily for 10 days
Famciclovir- (Famvir) 250 mg. #21. One tablet 3 times daily for 7 days
Acyclovir 400 mg #30 One tablet 3 times daily for 10 days
Acyclovir 200 mg one tablet 5 times daily for 7-10 days
Recurrent (Episodic) Episode
Begin treatment at prodome or within 1 day of onset of lesions with one of the following:
Valacyclovir (Valtrex) - 500mg. #6. One tablet twice a day for three days.
Valacyclovir (Valtrex) 1 gm - #5. One tablet every day for 5 days.
Famciclovir- (Famvir) 1 gm. #2. One tablet twice daily for one day.
Acyclovir - 400 mg #15. One tablet 3 times daily for 5 days
Provide herpes suppressive therapy to anyone with a valid history or lab diagnosis of herpes for one year. Re-evaluate annually.
Valacyclovir (Valtrex) 500 mg. #30 tablets. One tablet P.O. daily for 30-90 days with 4-11 refills by prescription.
Famciclovir (Famvir) 250 mg. #60 tablets. One tablet P.O. twice daily for 30-90 days with 4-11 refills by prescription.
Acyclovir 400 mg #60 tablets. One tablet P.O. twice daily for 30- 90 days with 4 -11 refills by prescription.
For more information on HSV treatment options, see CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015.