What are the physical findings of primary (first-episode) herpes simplex virus (HSV) infections?

Updated: Mar 01, 2018
  • Author: Folusakin O Ayoade, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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This section describes physical examination findings of the herpetic lesion as it relates to primary and recurrent lesions of cutaneous or mucosal HSV infection. This can be related to either oral or genital infection. [1, 2, 5]

Herpes simplex virus type 1. Recurrent herpes is m Herpes simplex virus type 1. Recurrent herpes is most often noted clinically as herpes labialis, with clustered vesicles (often coalescing) on the lip vermilion and often on the perioral skin. Recurrences generally occur in the same area each time, although their severity may vary. Courtesy of Sara Gordon, DDS.

Primary mucocutaneous HSV infections

Some primary infections are asymptomatic.

Primary (first-episode) infections manifest within several days of exposure to secretions containing viable virus.

Often painful, the lesions quickly progress to vesicles and can continue to erupt over 1-2 weeks.

The lesions are prominent and are often present internally on the mucosal surface of the oral or genital area, as well as on the surrounding skin.

Constitutional symptoms (fever, malaise, myalgias, and anorexia) are often prominent. Weight loss is not uncommon and is due either to illness or dysphagia (in primary gingivostomatitis).

Individual vesicles on mucosal surfaces break down rapidly, forming shallow painful ulcers (usually < 8-10 mm in diameter). They may be covered with a white exudate that can be confused with mucosal candidiasis. Those on cutaneous surfaces remain as vesicles longer, only to evolve into crusted ulcers that heal within 5-7 days.

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