What happens during primary HSV infection?

Primary infection refers to an individual’s first infection with HSV, either type 1 or 2, at any site. These patients are seronegative initially but subsequently develop HSV-specific antibodies. During primary infection, HSV gains access to the host through the epithelial surface. Following active replication within the skin or mucosa, HSV infects the associated cutaneous neurons and migrates to the sensory root ganglia, where a latent infection is established. Primary HSV infection may be associated with extensive cutaneous lesions, severe pain, and systemic symptoms. However, in many cases, the primary infection is asymptomatic (or unrecognized).