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Genital herpes simplex virus in Child
See also in: Cellulitis DDx,Anogenital
Other Resources UpToDate PubMed

Genital herpes simplex virus in Child

See also in: Cellulitis DDx,Anogenital
Contributors: Susan Burgin MD, Belinda Tan MD, PhD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed


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.


A60.9 – Anogenital herpesviral infection, unspecified

33839006 – Genital herpes simplex

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Differential Diagnosis & Pitfalls

  • Cellulitis / superinfected traumatic erosions
  • Allergic contact dermatitis
  • Intertrigo
  • Fixed drug eruption
  • Molluscum contagiosum
  • Arthropod bite or sting
  • Folliculitis
  • Candidiasis
  • Bullous impetigo
  • Aphthous stomatitis
  • Behçet syndrome
  • Consider Herpes zoster if the lesions seem unilateral.
  • Erosive Lichen planus
  • Gas gangrene
  • Pyoderma gangrenosum
  • Ecthyma gangrenosum
  • Child sexual abuse
  • Bullous pemphigoid of childhood
  • Juvenile gangrenous vasculitis of the scrotum
  • Reactive nonsexually related acute genital ulceration
  • Mpox – Lesions beginning in the genital and anal area have been reported.

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Last Reviewed:12/14/2016
Last Updated:09/04/2023
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Patient Information for Genital herpes simplex virus in Child
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Genital herpes simplex virus in Child
See also in: Cellulitis DDx,Anogenital
A medical illustration showing key findings of Genital herpes simplex virus : Female genital, Grouped configuration, Male genital, Recurring episodes or relapses, Umbilicated vesicle
Clinical image of Genital herpes simplex virus - imageId=429198. Click to open in gallery.  caption: 'Grouped early vesicles and background erythema on the penile shaft.'
Grouped early vesicles and background erythema on the penile shaft.
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