The heterogeneous clinical spectrum of genital herpes.
OBJECTIVE
Most data of genital herpes have been collected in 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 clinic of dermatology.


METHODS
The charts of 170 patients, previously monitored prospectively for a HIV prevalence study, with culture-confirmed genital herpes or herpetic infection with HSV-2 at any other site presenting between 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 cluster of genital lesions. Eighty-six (51%) presented with either lesions at extragenital sites [mostly the buttocks 33/170 (19%), thigh 10/170 (6%), anal region 9/170 (5%) and fingers 8/170 (5%)] or showed morphologically atypical forms of isolated genital lesions [single ulcer 16/170 (9%), erosion 6/170 (4%), crust 3/170 (2%) and fissure, edema or erythema each 1/170 (1%)]. Women significantly presented more often with extragenital infections of HSV-2 [36/59 (61%)] than men [18/111 (16%)].


CONCLUSIONS
More than half of the patients with genital herpes of a mainly immunocompetent population presented with atypical manifestations. The underdiagnosis of genital herpes seems largely due to misinterpretation of atypical genital and extragenital lesions.
Lautenschlager
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Outpatient Clinic of Dermatology, Triemli Hospital, Zürich, Switzerland. stlauten@swissonline.ch
Eichmann
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D006558:Herpes Genitalis / Q000473:pathology* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D012725:Sexual Behavior; D012867:Skin / Q000473:pathology