Genital herpes is a sexually transmitted viral infection caused by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). The most common pediatric patient is a sexually active adolescent. Infection begins within 10 days after direct contact with active lesions on another infected individual; however, asymptomatic viral shedding is another well-established source of infection.

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.