Genital herpes

Exam relevance: in 7 of 197 board exam reports · rank 88

Synonyms: HSV
Specialty: Gynaecology · Vulva & vagina
Images: Clinical 5 · Endoscopy & gross 1
Exam relevance: 7 of 197 reports · rank 88
In the app: 2 flashcards · GynFuchs
Last updated: 10/2026 · Dr. Pascal Bafteh

Contents

Images (6)
Definition
Occurrence & epidemiology
Aetiopathogenesis
Clinical features
Diagnosis
Keep learning in the app
Further reading (selection)
Cross-references

Images (6)

Genital herpes – Clinical: Grouped, partly pustular vesicles on an erythematous base on the labium majus, along with small erosions — Grouped, partly pustular vesicles on an erythematous base on the labium majus, along with small erosionsImage: Commons-Uploader (Wikimedia Commons) · CC BY-SA 3.0 · Source

Genital herpes – Endoscopy & gross: Cytological smear in a herpes infection: multinucleated giant cells with ground-glass nuclei — Cytological smear in a herpes infection: multinucleated giant cells with ground-glass nucleiImage: Manuel Medina, Osuna (Wikimedia Commons) · Public domain · Source

Genital herpes – Clinical: Bartholin's cyst: a tense, elastic bulge in the posterior third of the right labium majus — Bartholin's cyst: a tense, elastic bulge in the posterior third of the right labium majusImage: Medimage (Wikimedia Commons) · CC BY-SA 3.0 · Source · cropped

Genital herpes – Clinical: Condylomata acuminata: cauliflower-like, bed-like papules in the perineal and perianal region — Condylomata acuminata: cauliflower-like, bed-like papules in the perineal and perianal regionImage: Dr.Gandikota Raghurama Rao (Wikimedia Commons) · CC BY 4.0 · Source · cropped

Genital herpes – Clinical: Vulvar haematoma: a tense, blue-livid swelling of one labium majus — Vulvar haematoma: a tense, blue-livid swelling of one labium majusImage: Raveiro R, Bengio M, Sharp J, et al. / Clin Pract Cases Emerg Med 2025 · CC BY 4.0 · Source · cropped

Genital herpes – Clinical: Genital herpes — Genital herpesImage: Falchetti da Silva J, Kayse Ferreira Araujo N, Bacellar Rosemberg et al. / Cureus 2026 · CC BY 4.0 · Source

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Definition

Genital herpes is an infection with herpes simplex virus type 1 or 2 that presents as a primary or recurrent infection.
The virus replicates in the epithelium, travels along sensory nerves to the ganglia, remains latent there and can reactivate periodically.

Occurrence & epidemiology

Epidemiology

Genital herpes is among the most common sexually transmitted infections; most cases are due to HSV-2, while HSV-1 is increasingly implicated.
Most HSV-2 infections remain unrecognised; HSV-2 prevalence is almost twice as high in women as in men.

Aetiopathogenesis

Aetiology and risk factors

Transmission is mostly sexual; the majority of transmissions occur from people without lesions who are unaware of their infection.
After primary infection, HSV-2 remains latent for life in the lumbosacral ganglia and can reactivate later.
The child is mostly infected during birth (about 85 % of neonatal infections) and rarely in utero (about 5 %); the risk is highest with primary maternal infection in the third trimester.

Clinical features

Recognition

Typical finding: grouped vesicles on an erythematous base.
Key symptom: severe pain, dysuria, urinary retention.
Additionally in a primary infection: fever and inguinal lymphadenopathy.
Pathogen: herpes simplex virus (HSV), esp. type 2, also type 1.
Diagnosis: PCR from vesicle base or erosion swab.

Genital herpes on the vulva

Clinical presentation: The typical signs are grouped vesicles on an erythematous base that erode painfully, often with lymph node swelling and dysuria.
Course: The primary infection is more severe than a recurrence, with systemic symptoms and fever.

Primary infection presents with painful genital ulcers, tender regional lymphadenopathy and frequently dysuria.
Grouped vesicles on an erythematous base rapidly ulcerate and crust; in primary infection the lesions usually heal within 2–3 weeks, and recurrences are shorter. In women, the vulva may swell markedly.
Primary infection is often accompanied by systemic symptoms such as fever, malaise and myalgia; recurrences are usually smaller and localised.

Diagnosis

Typical imaging findings

Clinical finding: Several grouped, partly pustular vesicles sit on an erythematous, slightly swollen base on the labium majus. Beside them are small flat erosions where vesicles have already ruptured; the lesions are markedly tender.
Clinical finding: Both labia majora bear large, sharply demarcated, bright red granular ulcerations. Classic grouped vesicles are absent; the margins are raised and the lesions are extensive and persistent.

For virus detection, a vesicle is unroofed and its base or the ulcer base is swabbed; PCR is most sensitive early in the course of the lesion.
PCR with typing distinguishes HSV-1 from HSV-2; type-specific serology can demonstrate past infection.

Keep learning in the app

In the GynFuchs app you can learn Genital herpes with flashcards, exam questions and image tasks (colposcopy, ultrasound, CTG) – free, in your browser or as an app.

In the app: 2 flashcards on this topic

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