Herpes Simplex Virus-1 Complicated by Postherpetic Neuralgia: A Case Report

The following case describes management of severe persistent vulvar pain from postherpetic neuralgia through a ganglion impar block.

A 21-year-old female patient initially presented with genital lesions consistent with herpes simplex virus-1 (HSV-1) and antibody testing suggestive of primary HSV-1 infection. After her genital lesions resolved, she continued to have severe persistent vulvar pain and was diagnosed with postherpetic neuralgia, approximately one year after initial presentation. After unsuccessful medical management with her gynecologist and primary care physician, she was referred to a specialty pain management clinic, where a ganglion impar block was performed and provided significant pain relief.

Genital HSV-1 is a rare cause of postherpetic neuralgia which can cause debilitating pain. Its management requires a multidisciplinary approach, including gynecology, pain management, physiatry, and if appropriate, behavioral health.