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Herpes simplex virus - Anogenital in
See also in: Overview,Cellulitis DDx
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Herpes simplex virus - Anogenital in

See also in: Overview,Cellulitis DDx
Contributors: Susan Burgin MD, Eric Ingerowski MD, FAAP, Belinda Tan MD, PhD, Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
Other Resources UpToDate PubMed


Genital herpes simplex is a viral infection that is caused by herpes simplex virus type 2 (HSV-2) and herpes simplex virus type 1 (HSV-1). It is seen frequently in sexually active adolescents but can also occur in younger children. Nonsexual acquisition by vertical transmission can take place at the time of birth, by hand contact during diapering, or by autoinoculation. However, new genital herpetic lesions in children without a history of perinatal acquisition who have independent toileting are suspicious for abuse and should be evaluated. Both types may be due to sexual abuse. An associated history of recurrent herpes gingivostomatitis or herpetic whitlow argues against abuse.

Infection by the virus is acquired from direct contact with active lesions, and symptoms develop within 5-10 days of initial contact. However, it is important to note that even when asymptomatic, a person sheds the virus and so can transmit the disease to another. In some adolescents, primary infection can be severe and include symptoms of aseptic meningitis such as fever, headache, stiff neck, and photophobia.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and of all economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.


B00.1 – Herpesviral vesicular dermatitis

88594005 – Herpes simplex

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Last Reviewed:12/14/2016
Last Updated:02/04/2016
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Herpes simplex virus (HSV) is a common infection that can cause skin or mouth sores, the latter of which are often called cold sores or fever blisters. The first eruption, or outbreak, is called primary herpes. This is often more severe than secondary, or recurrent, herpes infections.

Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) can cause infection. HSV-1 is the most common cause of lesions that appear around the mouth and on the lips. HSV-2 more commonly causes lesions on the genital area, although HSV-1 can also be a cause. HSV-2 can more rarely occur on virtually any body surface. HSV is highly contagious and is spread by direct contact with the lesions of another infected individual, such as a playmate, parent, or caretaker. The virus can even spread in the absence of symptoms or visible lesions.

The primary herpes episode usually heals in 7-10 days. Affected individuals carry the virus in their bodies for the rest of their lives, and this may lead to recurrences of outbreaks in the same skin area. Most people report burning, itching, and a tingling sensation in the area before the actual lesions appear.

Who’s At Risk

Infection with HSV is very common. Most people never even know they have been infected, as their immune system suppresses symptoms. At least one-third of children are infected by HSV by the end of childhood.

HSV infection may be more severe in newborns and in those with a weak immune system.

Signs & Symptoms

Most commonly, primary herpes in children involves painful blisters and erosions of the gums and the skin around or lining the mouth. There may also be fever, swollen lymph nodes in the neck, irritability, and a poor appetite. If HSV is introduced on other body sites, there may be painful blisters and sores in that location (eg, the finger, face, genitals), with swelling and similar symptoms affecting the entire body, such as fever and swollen lymph nodes.

Self-Care Guidelines

  • You can give acetaminophen (Tylenol) or ibuprofen (Advil, Motril) for the pain. It is important to relieve pain so that eating and sleeping are possible.
  • The child should be encouraged to drink as much fluid as possible to avoid dehydration.
  • Avoid contact with other children, especially newborns and those with eczema or a weak immune system, until healed.

When to Seek Medical Care

Although those with mild recurrent herpes do not usually require any medical care, see your child's medical professional if you think they have primary herpes or if your child has recurrent herpes with bothersome symptoms.


Antiviral medications may be prescribed, including acyclovir (Zovirax) or valacyclovir (Valtrex; only in children ages 12 years and older). Anesthetic mouthwashes or pain medication may be given to reduce pain. Sometimes a child will need to be given intravenous fluids for dehydration.
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Herpes simplex virus - Anogenital in
See also in: Overview,Cellulitis DDx
A medical illustration showing key findings of Herpes simplex virus : Grouped configuration, Recurring episodes or relapses, Umbilicated vesicle
Clinical image of Herpes simplex virus - imageId=111180. Click to open in gallery.  caption: 'A close-up of grouped cloudy vesicles on an erythematous base.'
A close-up of grouped cloudy vesicles on an erythematous base.
Copyright © 2023 VisualDx®. All rights reserved.