title: Clinical course of patients with serologic evidence of recurrent genital herpes presenting with signs and symptoms of first episode disease.
abstract: OBJECTIVE
  The care of patients with first episode and recurrent genital herpes differs with respect to therapy and source partner evaluation. Of 498 persons who presented with what appeared by history and symptoms to be a first episode of genital herpes, we identified 41 who had serologic evidence of remotely acquired herpes simplex virus 2 (HSV-2) infection.
  
  
  OBJECTIVE
  To define the natural history of these individuals with previously unrecognized HSV-2 and to evaluate if any clinical or historical features could differentiate these people from persons with true first episode infection.
  
  
  METHODS
  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 recently acquired genital herpes. The frequency of new sexual partners and recent sexual history were also similar in the two groups. However, on follow-up, the lesions of persons with remotely acquired HSV-2 healed more rapidly 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 evidence of remotely acquired HSV-2, suggesting that clinical differentiation of first episode genital herpes from previously acquired infection is difficult. Type-specific serologic testing assists the clinician in correctly classifying the infection and determining the potential source partner.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: C
authors.initials: C
authors.lastname: Diamond
authors.forename: S
authors.initials: S
authors.lastname: Selke
authors.forename: R
authors.initials: R
authors.lastname: Ashley
authors.forename: J
authors.initials: J
authors.lastname: Benedetti
authors.forename: L
authors.initials: L
authors.lastname: Corey
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006558:Herpes Genitalis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D018258:Herpesvirus 2, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000914:Antibodies, Viral