The heterogeneous clinical spectrum of genital herpes

Background and Objective: Most data of genital herpes have been collected i n STD clinics in the USA where unrecognized forms accounted for 80% of HSV- 2 infections. Our aim was to study the clinical features in an outpatient c linic of dermatology. Methods: The charts of 170 patients, previously monit ored prospectively for a HIV prevalence study, with culture-confirmed genit al herpes or herpetic infection with HSV-2 at any other site presenting bet ween 1995 and 1999 were analyzed. Results: 111 (65%) men and 59 (35%) women were identified with a mean age of 44 years. Only 49% had a typical cluste r of genital lesions. Eighty-six (51%) presented with either lesions at ext ragenital sites [mostly the buttocks 33/170 (19%), thigh 10/170 (6%), anal region 9/170 (5%) and fingers 8/170 (5%)] or showed morphologically atypica l forms of isolated genital lesions [single ulcer 16/170 (9%), erosion 6/17 0 (4%), crust 3/170 (2%) and fissure, edema or erythema each 1/170 (1%)]. W omen significantly presented more often with extragenital infections of HSV -2 [36/59 (61%)] than men [18/111 (16%)]. Conclusions: More than half of th e patients with genital herpes of a mainly immunocompetent population prese nted with atypical manifestations. The underdiagnosis of genital herpes see ms largely due to misinterpretation of atypical genital and extragenital le sions. Copyright (C) 2001 S. Karger AG, Basel.