Clinical manifestations of genital herpes?

  Sixty-three percent of HSV2 and 37% of HSV1 initial infections do not present with clinical symptoms. Typical symptoms include pain, difficulty urinating, increased urethral or vaginal discharge, painful inguinal lymph node enlargement, and involvement of the rectum, which may manifest as rectal pain, increased discharge, and urgency.  Generally, genital herpes is classified as primary, recurrent, subclinical, atypical, and asymptomatic.  Primary genital herpes is the first infection with HSV and clinical signs and symptoms appear. The incubation period is 2-14 days (average 3-5 days); typical manifestations are multiple erythema, papules, and blisters widely and symmetrically distributed in the external genital area, which break down to form vesicles or ulcers after 2-4 days. Early symptoms may include itching or burning in the genital or anal area, headache, fever, swollen lymph nodes, etc. The duration of the disease is mostly 2-3 weeks.  2, recurrent genital herpes Most commonly seen in genital HSV-2 infected patients; generally the first recurrence occurs 1-4 months after the primary infection. The frequency of recurrence averages 3-4 times per year. Most patients present with prodromal manifestations hours to 5 days before the onset of the rash, ranging from mild numbness, tingling, burning, stinging, vague pain and perineal cramps to radiating pain in the buttocks, thighs and hips; the lesions are small in number, clustered small blisters, soon forming vesicles or shallow ulcers, asymmetrically distributed, with mild local pain, pruritus and burning sensation; the duration of the disease is usually 6 to 10 days, with the lesions healing in 4 to 5 days.  3.Subclinical infection HSV infection without clinical signs and symptoms. However, there is asymptomatic detoxification, which can be infectious.  4.Atypical or unrecognized genital herpes Atypical lesions can manifest as tiny fissures, ulcers, and erythema in the genital area, which can be easily overlooked.  5. Special types of genital manifestations are herpes herpetiformis proctitis, herpes cervicitis, neonatal herpes disseminated HSV infection (manifested as herpes meningitis, hepatitis, pneumonia and skin infection), genital herpes during pregnancy (which can cause intrauterine growth retardation, miscarriage, premature birth or even stillbirth), etc.  6, AIDS and HSV infection can be manifested as widespread, multiple, chronic persistent ulcers with severe pain, susceptible to herpetic meningitis and disseminated HSV infection.