Acute first episode disease presents with vesicles over wide areas. Recurrent disease shows vesicles confined to a small area.
Recurrent herpes usually occur in exactly the same area with each recurrent episode. Vesicles clear and are replaced with erosions and then crust. Healing is without scarring unless the inflammation is intense enough to cause ulcers. Then physical examination during inactive periods shows a group of punctate scars.
Tender lymphadenopathy occurs during the first acute episode. Some patients experience tender lymphadenopathy during a recurrence.
Herpes simplex infection of the buttocks occurs almost exclusively in women. The origin of infection at this site is still unknown. The disease may recur frequently at this site and may show multiple sites of recurrence at the same time. This can be debilitating.