The most common symptoms are vesicles on an erythematous base However, as the vesicles are friable, unroofed painful ulcers may instead be noted on examination Painful regional adenopathy is common, especially with the primary infection The virus grows readily in standard viral culture HSV identified from genital lesions should be typed; while HSV-1 can be autoinoculated into the genital region from oral infection, sexual abuse needs to be considered in prepubertal children with genital HSV-2 PCR assays are also commercially available Type-specific antibodies not enable differentiation of orolabial and anogenital infections and are plagued with both false-negative (in early infection) and false-positive results Antiviral therapy is recommended for patients with initial and recurrent genital HSV infection to shorten symptom duration and decrease viral shedding There are fewer data on the utility of antiviral therapy for mucocutaneous HSV in immunocompetent hosts Acyclovir remains the first-line therapy (20 mg/kg every hours [maximum: 800 mg/dose] for young children and 400 mg three times daily for postpubertal patients) for to days An alternative regimen for older patients who can swallow pills is valacyclovir (1 g twice daily for to 10 days), which may increase adherence given the less frequent dosing interval Topical acyclovir is not recommended for herpes labialis or gingivostomatitis Contact precautions are recommended for children with mucocutaneous HSV Human Immunodeficiency Virus CLINICAL PEARLS AND PITFALLS Acute HIV infection presents as a mononucleosis-type illness; serologies often are negative, and the diagnosis is contingent upon PCR Knowledge of the child’s CD4+ cell count can allow the clinician to determine which opportunistic infections (OIs) are most likely Antiretroviral therapy has a host of potential adverse events, as well as multiple potential drug interactions that can result in toxicity Current Evidence It is estimated that there are approximately 11,000 children living with HIV in the United States and 1.8 million globally While HIV acquired vertically from mothers to infants has declined in recent years (approximately 100 cases of perinatal infection are reported annually in the United States), racial disparities