FREQUENCY AND REACTIVATION OF NONGENITAL LESIONS AMONG PATIENTS WITH GENITAL HERPES-SIMPLEX VIRUS

OBJECTIVE: TO determine the frequency, recurrence patterns, and host f actors associated with nongenital herpes simplex virus lesions. PATIEN TS AND METHODS: In this cohort study at a referral clinic, 457 patient s with first episodes of genital herpes were prospectively observed to evaluate the anatomic sites of herpetic lesions at the first and subs equent visits. Of these patients, 73 had primary genital herpes simple x virus (HSV) type 1, 326 had primary first episode genital HSV-2, and 58 had HSV-1 infection prior to acquisition of genital HSV-2. The med ian follow-up was 63 weeks. RESULTS: Nongenital lesions at the time of acquisition of genital herpes were observed in 25%, 9%, and 2% of pat ients with primary HSV-1, primary HSV-2, and nonprimary HSV-2, respect ively Half of the patients with concurrent genital and nongenital lesi ons subsequently had recurrences at a nongenital she. Twenty patients (6.5%) whose primary genital HSV-2 infection involved only the genital ia subsequently developed nongenital recurrences, primarily on the but tocks (12) and legs (4). Nongenital recurrences, especially buttock re currences, tended to be less frequent but of longer duration than geni tal recurrences. CONCLUSIONS: Overall, 21% of patients with primary ge nital herpes will have or will subsequently develop a nongenital recur rence. Among patients with HSV-1, nongenital lesions tended to occur m ore often on the hand and face, whereas HSV-2 lesions appeared more of ten on the buttocks. Buttock lesions due to HSV recur less frequently but last longer than genital lesions.