Patients with herpes can be asymptomatic, in addition to the following:

■ Primary infection: Painful multiple vulvar vesicles, associated with fever, lymphadenopathy, malaise, usually 1 to 3 weeks after exposure

■ Recurrent infection: Recurrence from viral stores in the sacral ganglia, resulting in a milder version of primary infection including vesicles.

■ Initial primary infection: This is defined as initial infection by HSV-II in the presence of preexisting antibodies to HSV-I. The preexisting antibodies to HSV-II can make the presentation of HSV-I milder.

Stress, illness, and immune deficiency are some factors that predispose to herpes recurrence.

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