I have never heard of a patient who had systemic symptoms of initial herpes without having recognized lesions. If it occurs, it is uncommon.
I'll go straight to your questions.
1) Probably about half to 2/3 of people with new genital herpes get lesions. However, many of those are mild and not noticed, so up to 70-80% say they are asymptomatic. But many of those would see an abnormality if they knew what to look for.
2) I suppose it is possible to have an asymptomatic or unrecognized initial genital infection, and still have symptomatic auto-inoculation to another part of the body. But it has to be rare and I have never seen such a case.
3) HSV probably has to be massaged into the skin or tissues for infection to 'take'. There may be exceptions, but auto-inoculation by less direct transmission (e.g., via semen) either doesn't occur or is very rare.
4) Recurrent HSV-2 outbreaks are uncommon at non-genital sites. I have never seen a person with recurrent HSV-2 outbreaks of the eye, mouth (oral herpes), fingers, etc--even though they are the main sites of auto-inoculation in people with initial genital herpes. Only a tiny percentage of people with recurrent oral herpes have HSV-2, for example--even though several percent of people with primary genital herpes have oral as well as genital infection.
Good luck-- HHH, MD
Dr H,
Many thanks for your response. Just out of interest, do those who experience systemic effects normally have lesions (x & y), or is there no definitive link (x or y)?
Kind regards
Many thanks Dr H. Great site, great service.
Kind regards,
BoxOfRocks