First-episode primary genital herpes is characterized by fever, headache, malaise, and myalgias (See Chap. 83. Sexually Transmitted and Reproductive Tract Infections). Pain, itching, dysuria, vaginal and urethral discharge, and tender inguinal lymphadenopathy are the predominant local symptoms.

• Pts with prior HSV-1 infection have milder cases.
• Reactivation infections are often subclinical or can cause genital lesions or urethritis with dysuria.
• Even without a history of rectal intercourse, perianal lesions can occur as a result of latency established in the sacral dermatome from prior genital tract infection.