Genital herpes is a sexually transmitted disease caused by herpes simplex virus (HSV) infection of the genital and perianal skin and mucous membranes, often in a chronic and recurrent course, for which there is no method of eradication, but which can be cured clinically with proper treatment. The diagnosis of this disease is generally not difficult. Now according to China’s CDC guidelines to prepare the article for the majority of friends for reference. I. Diagnosis based on 1. epidemiological history History of non-marital sexual contact or history of spousal infection. 2, clinical manifestations (1) primary genital herpes: the first HSV infection and the appearance of symptoms is primary genital herpes. The incubation period is 6 days on average. It is characterized by severe skin lesions, often with systemic symptoms. It is characterized by multiple erythema, papules and blisters on the vulva, which break down after 2-4 days to form erosions or ulcers, with self-induced pain, itching and burning sensation, often accompanied by systemic symptoms such as fever, headache, myalgia, general malaise or fatigue. There may be manifestations of urethritis, cystitis or cervicitis. It may be accompanied by enlarged inguinal lymph nodes with pressure pain, but without suppuration and rupture. The duration of the disease is usually 2-3 weeks. Some patients have had HSV-1 infection (mainly oral or facial herpes) and have a first episode of genital herpes with HSV-2 infection, which is not primary genital herpes. Compared with the primary genital herpes described above, the conscious symptoms are milder, the lesions are more limited, the duration of the disease is shorter, systemic symptoms are less common, and the inguinal lymph nodes are mostly not enlarged. (2) Recurrent genital herpes The first episode occurs mostly 1-4 months after the primary infection. The frequency of recurrence varies widely among individuals, with an average of 3-4 times per year, and more than 10 or even tens of times per year in frequent cases. Most of them have prodromal symptoms from a few hours to 5 d before the onset of the rash, manifested as local itching, burning, tingling, vague pain, numbness and perineal swelling. The number of lesions is small, and the conscious symptoms are mild local pain, itching, burning sensation, and systemic symptoms are rare. The duration of the attack is often 6-10 d, and the lesions heal within 4-5 d. (3) Subclinical infection refers to HSV infection without clinical signs and symptoms. Although there are no signs and symptoms of subclinical infection, there is asymptomatic detoxification, which can be infectious. (4) Atypical or unrecognized genital herpes Many infections that are considered asymptomatic are not really asymptomatic, but simply have unrecognized symptoms. Atypical damage can be classified as nonspecific erythema, fissures, sclerosis, folliculitis, skin abrasions, and foreskin erythema and ooze. (5) Special types of genital herpes ① Herpetic cervicitis HSV infection of the uterine cervix may manifest as mucopurulent cervicitis. It is manifested by congestion and increased fragility of the cervix, erosion, and even necrosis. Herpetic proctitis Most often seen in men who have sex with men, with an acute onset, manifested by pain in the anal region, urgency, constipation and rectal mucous bloody discharge, often accompanied by fever, general malaise and myalgia. About half of the patients have perianal blisters or ulcers. (6) Neonatal herpes The risk of fetal infection from primary herpes is much higher than that of recurrent herpes. Primary herpes is associated with miscarriage, preterm birth, intrauterine growth retardation, low birth weight, and can even cause stillbirth. In pregnant women infected early in pregnancy, babies are often delivered with congenital malformations and brain calcification, and affected children are often mentally retarded. Herpes neonatorum is classified into limited, central nervous system and disseminated types, mostly seen in premature infants, which are rarely symptomatic at birth and often occur 3-28 days after birth, invading the skin mucosa, internal organs and central nervous system. The manifestations are fever, lethargy, weakness during feeding, convulsions or skin lesions. Conjunctivitis and keratitis may occur, sometimes accompanied by yellow bile, cyanosis, respiratory distress and circulatory failure leading to death. Neonatal herpes is a dangerous disease, the death rate can be as high as 50% or more, and those who are lucky enough to survive are often left with sequelae. (7) Complications are rare and are related to the local spread and hematogenous dissemination of HSV. The main types are as follows. (1) Central nervous system complications: including aseptic meningitis, autonomic dysfunction, transverse myelitis, and sacral radiculopathy. (ii) Disseminated HSV infection: including disseminated skin infection, herpetic meningitis, hepatitis, pneumonia, etc. (③) Local spread of HSV: causes pelvic inflammatory disease, adnexitis, and aseptic prostatitis. 3, laboratory tests (1) virus culture This method is the “gold standard” for laboratory diagnosis of genital herpes, with good sensitivity and specificity, but requires high laboratory conditions and is time-consuming, and cannot be detected by general medical institutions. (2) Antigen detection Immunological methods are used to detect HSV, including immunofluorescence test, immunoenzymatic staining and enzyme-linked immunosorbent assay. (3) Nucleic acid and genetic tests Polymerase chain reaction (PCR) has good sensitivity and specificity and can be used to type HSV at the same time, but should be performed in laboratories accredited by the national health authorities. Type-specific serological diagnostic methods (protein blotting and partial ELISA tests) Using glycoprotein G of HSV as antigen, it is possible to detect and distinguish between two types of HSV serum antibodies in a sensitive and specific manner. However, the sensitivity and specificity of different reagents vary greatly, so the results need to be analyzed in conjunction with clinical integration. (1) Clinical diagnosis: clinical manifestations of genital herpes, with or without epidemiological basis. (2) Confirmed cases: In addition to meeting the requirements of clinical diagnosis and laboratory tests in any one of the three items. (1) Hard chancre: mostly a single round ulcer with slightly elevated periphery, hard and painless, with painless inguinal lymph node enlargement, dark-field microscopic examination reveals syphilis spirochetes, and syphilis serological test is mostly positive. (2) Soft chancre: deep ulcers with unintegrated margins, surface discharge and satellite lesions, often with purulent inguinal lymphadenitis. (3) Behçet’s syndrome (leukodystrophy): genital ulcers are large and deep, long lasting, and may be accompanied by erythema nodosum, folliculitis, often with ocular uveitis and central nervous system symptoms such as headache, dizziness, and mental abnormalities. (4) Other skin diseases: Herpes zoster, contact dermatitis, fixed drug rash, impetigo, Reiter’s disease, candidiasis and other skin diseases in the genital area, the lesions are sometimes similar to genital herpes and can be differentiated from the medical history, physical examination and laboratory tests.