Genital herpes is a sexually transmitted disease caused by herpes simplex virus (HSV) infection of the skin and mucous membranes of the genital and anal regions of the urinary tract. HSV can be divided into type 1 (HSV-1) and type 2 (HSV-2), and genital herpes is mainly caused by HSV-2, but can also be caused by HSV-1 or a mixture of both types. Epidemiology Seroepidemiological surveys and clinical case reports have shown a significant increase in the incidence of the disease, but it is difficult to accurately assess the prevalence of the disease in China due to factors such as survey methods, survey population and subclinical infections and atypical presentations. The disease is mainly transmitted through direct skin/mucous membrane contact, and infection by other means is extremely unlikely; therefore, unsafe sex is a high risk factor for the development of the disease. The risk of co-infection with HIV has been clinically found to be significantly higher in the population of patients with genital herpes, which may be related to the disruption of the skin-mucosal barrier caused by the former or the existence of complex interactions between the two viruses. In recent years, there has been an increase in genital herpes caused by HSV-1 infection, which may be related to changes in sexual behavior. III. Clinical manifestations Genital herpes can be divided into primary, recurrent, and subclinical HSV-activated types, and in addition there are some special types with their own characteristics of clinical manifestations. (a) Primary genital herpes The first clinical manifestations include primary genital herpes (primary genital herpies) (first HSV infection) and non-primary primary genital herpes (previous HSV infection). The incubation period is usually 2 to 14 days, and patients generally have a long duration of illness, which can last 5 to 20 days. The disease is severe and can be combined with systemic symptoms (such as fever, headache, general malaise and muscle aches). The affected area is erythematous in the early stages and rapidly develops into blisters, erosions and ulcers, with significant local pain and increased vaginal discharge in women due to involvement of the cervix. In some patients, the lesions are more extensive and can occur outside the genital area. (b) Recurrent genital herpes Most cases can develop into recurrent genital herpes. Systemic symptoms are rare, lesions are limited, and the duration of the disease is relatively short, usually lasting 6-10 days. The frequency of recurrence varies greatly among individuals, with an average of 3 to 4 times/year, and frequent episodes can exceed 10 times per year. 1. Typical manifestations: Most of them have prodromal symptoms such as local itching, burning, tingling, vague pain, numbness and perineal swelling a few hours to 5 days before the onset of rash, followed by clusters of small blisters, which soon break down to form vesicles or superficial ulcers, with lighter self-conscious symptoms than the initial ones, lasting 6-10 days and then healing. 2. Atypical manifestations: It may manifest as non-specific limited erythema, punctate vesicles, fissures, ulcers, exudates, hard nodules (or boils) and folliculitis, etc., which need to be distinguished from other diseases. (iii) Subclinical HSV activation HSV is activated in the body without clinical manifestations, but can be intermittently detoxified. Viral activation can occur at multiple anatomic sites (e.g., vagina, cervix, rectum, etc.), and the virus can be isolated from normal-appearing affected sites in this type of patient. The greatest risk in patients with subclinical HSV activation is that of infectious partners. Studies have shown that 70% of transmission occurs after sexual contact in patients with subclinical HSV activation, and that women are more likely to be infected. (d) special types of genital herpes 1, neonatal herpes: can be divided into limited, central nervous system type and disseminated type, for the serious type of the disease, almost always infected by contact with the birth canal during childbirth, can endanger the lives of children. 2. Herpetic cervicitis: manifests as mucopurulent cervicitis, which can present with cervical congestion, increased fragility, blistering, mucosal erosion and even necrosis. 3, herpes proctitis: mostly seen in men who have sex with men, can be manifested as perianal blisters, ulcers, self-conscious pain, can also be manifested as urgency, constipation and rectal mucus bloody discharge, often accompanied by fever, general malaise, myalgia, etc. The sensitivity is related to the different lesion patterns such as erythema, blisters and crusts, and the success rate of viral culture is relatively high for blisters. Since the viral load of primary genital herpes is much higher than that of recurrent, its viral culture success rate is also higher. 2. Antigen detection HSV antigen can be detected by enzyme-linked immunosorbent assay or immunofluorescence test, but the virus type cannot be distinguished. When HSV infection is suspected but there are no lesions or lesions are atypical, antigen detection can be used to identify subclinical HSV activation or atypical genital herpes. 3, nucleic acid detection PCR can detect HSV-DNA, its significance is similar to antigen detection, but more sensitive, because its clinical application is limited by equipment, price and false positive problems, less routinely carried out. 4, serum antibody detection ELISA or Western blot test can detect serum medium-sized specific antibodies, and can be used to distinguish the virus type. However, because serological testing is influenced by a variety of factors such as infection status and methodology, antibody testing is only used as a clinical adjunct to the diagnosis of genital herpes, combined with a comprehensive clinical analysis, and cannot be used alone as a basis for confirming or excluding the diagnosis. At present, antibody testing is mostly used for epidemiological investigation and retrospective clinical analysis. V. Diagnosis 1. Diagnostic criteria Clinical diagnostic criteria: history of unsafe sex, self or sexual partner infection, and typical clinical manifestations, atypical lesions need to be combined with pathogenic examination to confirm the diagnosis. Pathogenic diagnostic criteria: clinical diagnostic criteria plus positive pathogenic examination results. In addition, some skin diseases (such as herpes zoster, contact dermatitis, fixed drug rash, pyoderma, Reiter’s disease, candidiasis, etc.) may also cause similar manifestations and need clinical attention.