Genital herpes simplex virus in Child
Sexual abuse must be considered in all young children with genital HSV. Abuse affects children of all ages and backgrounds and, if suspected, needs appropriate referral. Other sources of infection in young children are autoinoculation from herpetic disease of the fingers (herpetic whitlow), innocent inoculation from a caregiver with herpetic whitlow, and close nonsexual physical contact.
Mucocutaneous HSV infection is characterized by initial outbreaks (primary infection), periods of latency (regional sensory ganglia), and recurrent flares localized to the area of the initial outbreak (recurrent infection).
The initial eruption usually develops within 5-7 days of inoculation and consists of painful vesicles, pustules, and/or erosions on an erythematous base that are scattered over the affected anatomic site. A prodrome of fever, malaise, and lymphadenopathy may precede or accompany the primary mucocutaneous eruption. Recurrent eruptions are usually less severe (fewer lesions, more localized, and less painful), resolve within 1 week, and lack a prodromal phase.
A60.9 – Anogenital herpesviral infection, unspecified
33839006 – Genital herpes simplex
Differential Diagnosis & Pitfalls
- Cellulitis / superinfected traumatic erosions
- Contact dermatitis
- Fixed drug eruption
- Molluscum contagiosum
- Insect bites
- Bullous impetigo
- Aphthous ulcers
- Behçet syndrome
- Consider herpes zoster if the lesions seem unilateral.
- Erosive lichen planus
- Fournier or gas gangrene
- Pyoderma gangrenosum
- Ecthyma gangrenosum
- Sexual abuse
- Bullous pemphigoid
- Juvenile gangrenous vasculitis of the scrotum
- Lipschutz ulcer
- Mpox – Lesions beginning in the genital and anal area have been reported.