Clinical course of patients with serologic evidence of recurrent genital herpes presenting with signs and symptoms of first episode disease

Background and Objectives: The care of patients with first episode and recu rrent genital herpes differs with respect to therapy and source partner eva luation. Of 498 persons who presented with what appeared by history and sym ptoms to be a first episode of genital herpes, we identified 41 who had ser ologic evidence of remotely acquired herpes simplex virus 2 (HSV-2) infecti on. Goals: To define the natural history of these individuals with previously u nrecognized HSV-2 and to evaluate if any clinical or historical features co uld differentiate these people from persons with true first episode infecti on. Study Design: Observational cohort study. Results: Clinical overlap existed in the frequency of local symptoms, fever , and size of genital lesions between those with remotely acquired versus r ecently acquired genital herpes. The frequency of new sexual partners and r ecent sexual history were also similar in the two groups. However, on follo w-up, the lesions of persons with remotely acquired HSV-2 healed more rapid ly and subsequently recurred less frequently than those of true primary HSV -2. Conclusions: Even in a referral clinic with experienced clinicians, almost 10% of persons who are judged to have first episode genital herpes have evi dence of remotely acquired HSV-2, suggesting that clinical differentiation of first episode genital herpes from previously acquired infection is diffi cult. Type specific serologic testing assists the clinician in correctly cl assifying the infection and determining the potential source partner.