Frequency and duration of patient-observed recurrent genital herpes simplex virus infection: characterization of the nonlesional prodrome.

For assessment of the natural history of patient-observed episodes of genital herpes, 32 patients with culture-proven, recurrent herpes were studied during 340 disease episodes for approximately seven and one-half months. Prodromes were experienced by 29 patients (90.6%) in 201 episodes (59.1%). Nonlesional prodromes were observed in 67 episodes (19.7%) and occurred at least once in 14 patients (43.8%). Vesicles were more likely to occur in men, wet ulcers in women. When all episodes were considered, the time to total healing was 5.65 +/- 3.73 days. Excluding episodes of nonlesional prodrome, the time to total healing was 6.83 +/- 3.7 days. Nonlesional prodromes occur commonly and usually resolve without therapy. Recurrent disease as observed by the patient is shorter than recurrent disease as observed in the clinic; this observation may affect the outcome of patient-initiated therapeutic trials.