Definition And Desert

This affection is characterised by the development of crops of vesicles on the genital organs. It is most frequenty met with on the penis, and occurs either on the integumentary surface or on the adjoining mucous membrane.'The vesicles resemble those of herpes labialis, and when seated upon mucous membrane rupture in a few hours, or a day perhaps, after their appearance. On rupture they leave little excoriations or ulcers which, if the patient's health be good, heal in a few days. In other cases the ulcerations may extend, neighboring ones unite and give rise to a condition that may readily be mistaken for venereal sores. One of the favorite tricks of charlatans is to inform the patient that they are of venereal origin, in fact, a manifestation of syphilis, and milk his pocket accordingly.

A peculiarity of herpes progenitalis is the tendency to frequent relapses or returns of the affection. The first attack having disappeared, another may occur in six weeks, two months, or later, and this be followed by others at somewhat irregular intervals, the disease in this way continuing to annoy the patient for several years. The vesicles are not, as a rule, accompanied with much pain. Sometimes there is a little itching, and, after rupture of the vesicles, a little soreness if the organ be roughly used.

In the female the vulva may be the seat of a similar affection, usually termed herpes vulvaris. It pursues the same course as in the male, and a relapsing form is sometimes met with.

Diagnosis

The diagnosis of Herpes progenitalis is not always easy. A simple unirritated herpes should not be mistaken for anything else, as the absence of all induration is usually sufficient to exclude chancre, at least in the male. The absence of purulent secretion in like manner excludes the chancroid. Where, however, the herpes has been irritated, little ulcerations with free secretion may closely simulate chancroids, and also a form of chancre described by the French as "multiple herpetiform chancre." In these cases it may be extremely difficult to positively determine the true nature of the lesion in question, time alone declaring this with certainty.

The diagnosis between Herpes progenitalis and Zoster should not be difficult. This latter affection rarely invades the genital regions, but when it does so it possesses its ordinary characteristics, namely, clusters of vesicles on inflamed patches of integument, accompanied with neuralgic pain.

Prognosis

The prognosis of simple herpes preputialis or vulvaris is always good, so far as the present attack is concerned, as a week usually suffices to end the matter. The prognosis as regards relapse, however, is not so good, and cannot be declared with any certainty. That is, at the first attack it will be impossible to say whether others will occur, and if they do whether the tendency to relapse will be overcome by treatment.

Etiology

The etiology of Herpes progenitalis is obscure. It is not a febrile affection like Herpes labialis, nor is there any reason to believe that it depends on any grave nerve-lesion as in Zoster. The individual attacks usually appear to be excited by peripheral irritation (phymosis sometimes) but the relapses are often unexplainable.

Treatment

The treatment of this form of herpes involves the use of means calculated to relieve the existing eruption, and to prevent relapses. As regards the temporary treatment nothing, as a rule, is required beyond cleanliness and the application of a little simple dusting powder. If ulcerations are present, a little stimulating ointment, as one containing a small quantity of balsam of Peru, or the Ungt. Resinae, may be employed.

The prevention of relapse is a much more difficult matter. The affection not unfrequently occurs in persons with a phymosis or a redundant prepuce. I have known of two oases in which curtailment of the redundancy put a stop to the recurrence of affection. In others the mucous membrane of the balano-preputial region is very delicate and sensitive. In these cases much benefit will accrue from a systematic application of astringents, tannin, catechu, etc., with a view to toughening the membrane. Thus far, in my own hands, internal medication has failed to prove of any certain service, except that in a few cases quinine, in full doses, has appeared to control the disposition to relapse.