Current understanding of the natural history of genital herpes simplex infections

Considerable variations in the disease make an accurate portrayal of genital herpes simplex virus (HSV) infections quite difficult. Primary genital HSV infections classically produce ulcerated lesions lasting a mean of 16-21 days in men and 10-16 days in women. HSV shedding has been documented for a mean of 9.1-11.6 days in men and 8.0-14.7 days in women. Probably many adults have a less severe initial genital infection, however, and it may be so mild as to be misdiagnosed or undetected. Studies of recurrent genital HSV infections are often misleading because they overestimate the frequency and severity of recurrences. By necessity, these studies have recruited and evaluated those adults with the worst and most frequent recurrences. Data from these studies show even greater variations than do data on initial episodes of genital HSV infection. The frequency and clinical importance of asymptomatic genital HSV shedding are being recognized and documented only now. Further studies of this phenomenon and of the natural history of all genital HSV infections are needed urgently.