Subsequently, crusts are formed and eventually, they heal spontaneously with no scarring. In women, lesions usually occur on the labia minora, clitoris, perineum, perianal area and the cervix. In men, the penis, perianal area and anus are commonly involved sites. Cutaneous lesions and viral shedding last about 2 weeks. It takes another 1 week for the lesions to heal.
Anorectal herpes gives rise to pain, discharge and constipation.
Bilateral tender inguinal lymphadenopathy is a common associated feature of primary but not recurrent attacks. After penetrating the host mucocutaneous surface, HSV is taken up by the peripheral sensory nerves and is carried centripetally to the sensory or autonomic ganglion, where they establish prolong, latent infection. Reactivation of latent infection gives rise to local recurrent skin lesions. Recurrent infection tends to be more localized, shorter duration and produces less systemic symptoms than the primary attack. They may precede the localized painful erythematous vesicles or ulcerations by 24-48 hours.