Herpes Progenitalis

The term herpes progenitalis includes the herpetic affections of the genital organs of both sexes, and, when occur­ring in the male, is called herpes preputialis, and in the female herpes vulvaris.

Herpes preputialis most frequently occurs in young men between the ages of 20 and 40, and is not often met with as a first attack after that age. The vesicles may form on both the cutaneous and mucous surfaces. Owing to the anatomical situation of these parts, and to the friction to which they are more or less subject, the vesicles last for but a few hours only, breaking and giving rise to superficial erosions, which from neglect or uncleanliness may run into slight ulceration.In herpes vulvaris the lesions may be upon the labia majora or labia minora, or upon the prepuce of the clitoris, running the same temporary course as the other varieties of the affection.

Herpes progenitalis is not usually accompanied with much pain, unless the parts are subjected to undue friction. As in the male, herpes of the female organs is most frequently met with between the ages of 20 and 40. A single attack lasts for a few days only, but with many patients herpes proves to be a relapsing affection, and causing on this account serious inconvenience to those who are subject to it. In men, relapses may occur after almost every act of sexual intercourse, but curiously is much less frequent in married men than in those who indulge promiscuously and at irregular intervals only. In women of the town the affection is by no means uncommon1, but is very rarely met with in married women or virgins, except when the attacks coincide with menstrual periods.


In this connection I will quote from an article in the Journal, Cutaneous and Venereal Diseases, August, 1883, where Dr. Unna reports his experience. He has met with 200 cases in the female. He says: "In France, where pros­titution is under surveillance, and where excellent syphilographers abound, herpes progenitalis early attracted attention and was ascribed to an unnatural irritation of the sexual organs to which prostitutes are subject. Venereal diseases cannot be the cause, for in married women suffering from syphilis or gonorrhoea herpes is not found. In prostitutes, herpes occurs as often in those without as those with syphilis. Acute and chronic blenorrhoea often exist as factors in the development of herpes progenitalis, by the congestion of the parts which they induce. There are prostitutes who have an attack of herpes every time they menstruate. Less frequently pregnancy and the puerperal state induce a disposition to herpes progenitalis. Bruneau must be given credit for having shown that in women suffering with chronic metritis, cervicitis, etc., every herpetic eruption is preceded  by increased  sensibility  and signs of heightened congestion of the pelvic organs. While the vesicles are still intact, the diagnosis is easy. The vesicles are yellowish translucent and arranged in clusters. When the epidermis has given way, the surface crusted over, erosion present, the surface must often be first carefully cleansed before we can say whether the disease be a superficial wound, a burn, eczema, chancre or herpes. Herpetic erosions are all well defined and of a bright reddish hue. They are discrete, coalescent or confluent. In any case, the sharply defined contour and crescentic arrangement make herpes easy of diagnosis. The parts most liable to this affection, in order, are the labia minora, pre­puce of the clitoris, labia majora, introitus vagina, and caruncula myrtiformis. The disease may be unsymmetrical when such organs as the prepuce of the clitoris, perineum, etc., are attacked. Pain usually precedes the eruption by several days."

The etiology of herpes progenitalis is obscure, and no adequate explanation has yet been given to account for the attacks.